There is some risk in every pregnancy, but some pregnancies have more risks than others. A high-risk pregnancy might pose challenges before, during or after delivery. If a woman has a high-risk pregnancy, she and her baby might need special monitoring or care throughout your pregnancy.
Antenatal care
All pregnant women are encouraged to have antenatal care, also called prenatal care, as early as possible. Ideally, such antenatal care generally commences between 9 – 12 weeks into pregnancy, and the purpose is to support women and their partners during pregnancy and identify potential problems with mother and baby early through detailed history risk taking and risk assessment. Good antenatal care is essential in providing choice for women. It is important that women and their partners are given the information to enable them to make an informed choice about all aspects of their pregnancy. Your obstetrician or other healthcare provider will carry out a risk assessment at the first visit to help decide if your pregnancy is considered a high-risk pregnancy.
What is a high-risk pregnancy?
Your pregnancy is called high-risk if you or your baby has an increased chance of a health problem.
In some cases a high-risk pregnancy is the result of a medical condition present before pregnancy. In other cases, a medical condition that develops during pregnancy for either expectant mother or baby causes a pregnancy to become high risk.
It is important to remember that being at high risk does not mean that you or your baby will have problems. It is just a way for doctors to make sure that you get special attention during your pregnancy. Your doctor will watch you closely during your pregnancy to find any problems early. These problems can then be dealt with appropriately.
Specific factors that might contribute to a high-risk pregnancy include the following:
• Advanced maternal age. Pregnancy risks are higher for mothers age 35 and older.
• Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put a pregnancy at risk.
• Medical history. A prior C-section, low birth weight baby or preterm birth — birth before 37 weeks of pregnancy — might increase the risk in subsequent pregnancies. Other risk factors include a family history of genetic conditions, a history of pregnancy loss or the death of a baby shortly after birth.
• Underlying medical conditions. Chronic conditions — such as diabetes, high blood pressure, severe anaemia and epilepsy — increase pregnancy risks.
• Pregnancy complications. Various complications that develop during pregnancy pose risks. These include problems with the uterus, cervix or placenta. Other concerns might include too much amniotic fluid (polyhydramnios) or low amniotic fluid (oligohydramnios), restricted fetal growth, or Rh (rhesus) sensitization — a potentially serious condition that can occur when your blood group is Rh negative and your baby’s blood group is Rh positive.
• Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher order multiples.
If you have a high-risk pregnancy, your healthcare provider might consider various tests or procedures in addition to routine prenatal screening tests.
Things to do to help with your pregnancy
Whether you have factors that cause you to think that you will have a high risk pregnancy or not, you should do the following to increase your chances of having a successful pregnancy:
• Schedule a preconception appointment. If you are thinking about becoming pregnant, consult your gynaecologist/obstetrician or another healthcare provider. He or she might counsel you to start taking a daily prenatal vitamin and reach a healthy weight before you become pregnant. If you have a medical condition, your treatment might need to be adjusted to prepare for pregnancy. Your healthcare provider might also discuss your risk of having a baby with a genetic condition.
• Seek regular prenatal care. Prenatal visits can help your healthcare provider monitor your health and your baby’s health. Depending on the circumstances, you might be referred to a specialist in maternal-fetal medicine, genetics, paediatrics or other areas.
• Eat a healthy diet. During pregnancy, you will need more folic acid, calcium, iron and other essential nutrients. A daily prenatal vitamin can help fill any gaps. Consult your healthcare provider if you have special nutrition needs due to a health condition such as diabetes.
• Gain weight wisely. Gaining the right amount of weight can support your developing fetus’s health — and make it easier to shed the extra pounds after delivery.
• Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs should be avoided. Get your healthcare provider’s permission before you start — or stop — taking any medications or supplements.
If you have a high-risk pregnancy, you might feel scared or anxious about your pregnancy.
What will change if you are considered high-risk?
A number of things will change if you are considered high-risk. You will have more visits to the doctor than a woman who does not have a high-risk pregnancy. You may have more ultrasound tests to make sure that your baby is growing well. Other monitoring might be increased. Your doctor may want you to have your baby in a hospital that offers special care for women and babies who may have problems. The timing of delivery might change as well.
Conclusion
Determination of a high-risk pregnancy might vary from country to country, but all agree that identification of high-risk pregnancies and appropriate management can improve the chances of a woman having a successful pregnancy. If your pregnancy is considered high-risk it is important to keep all your appointments and follow instructions from your healthcare provider. Women whose pregnancy are considered high-risk are often scared and anxious. These women should be reassured and be reminded that the vast majority of high-risk pregnancies result in a successful pregnancy.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
