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Notes on Women's Health
Notes on Women's Health

What Determines a Pregnancy High-Risk and What Can You Expect?

Pregnant woman with husbandMany women are concerned about health risks during pregnancy that may affect both themselves and their child. According to the National Institutes of Health (NIH), a high-risk pregnancy is “one that threatens the health or life of the mother or her fetus.” But what are these risk factors, and how do you know if your pregnancy is high-risk? And if your pregnancy is high-risk, how will your prenatal course differ from a “normal” pregnancy? We will answer these questions below and provide some general advice for women during a high-risk pregnancy.

What Makes a Pregnancy High-Risk?

There are hundreds of factors that could raise the risk of any pregnancy. These factors can be broadly separated into controllable and uncontrollable categories. Controllable risk factors include problems like smoking or other substance abuse, obesity and poor diet. Examples of uncontrollable risk factors are maternal age, family medical history, preexisting diseases like diabetes or cardiovascular disease, and infections such as HIV.

It is important to note that the term “uncontrollable” does not mean that the risk factor cannot be effectively addressed. While it may not be possible to remove the risk factor completely, the danger from these issues can often be mitigated through consistent and continuous prenatal care. For example, an expectant mother with diabetes can work with her physicians to maintain tight control of her blood sugars, and a pregnant woman with high blood pressure may need close monitoring.

Specific High-Risk Categories

It goes without saying that the use of harmful substances during pregnancy is a risk factor, in addition to more specific categories provided by the NIH:

Maternal Age

Maternal age is an uncontrollable pregnancy risk. Women who are in their teens or older than 35 have a higher risk of pregnancy complications than other women. These women may need more testing during their prenatal period due to their age.

Existing Health Conditions

Examples of chronic health conditions that may impact your pregnancy include, but are not limited to, high blood pressure, infections, cardiovascular problems and diabetes. While you cannot help having these conditions, the risks can be reduced by strictly following the advice of your healthcare providers.

Obesity

Mothers that are overweight or obese suffer pregnancy complications at a greater rate than mothers of a healthy weight. If you are planning to become pregnant, exercising and eating right before conception will help best prepare your body for pregnancy.

Multiple Births

Although these are uncontrollable risk factors, carrying twins, triplets, or more increases the possibilities for complications during pregnancy. Uterine crowding can occur, leading to high blood pressure and additionally, multiples may need to be delivered by Cesarean section (C-section).

What Can You Expect with a High-Risk Pregnancy?

In general, women with high-risk pregnancies will need more medical attention than other expectant mothers. This means you can expect more frequent office visits and more testing. Here are some specifics:

Testing

Depending on the nature of your risk, you may need to undergo considerable testing during your pregnancy. These tests will likely include laboratory assessments of your blood and urine, ultrasounds, physical exams including pelvic examinations, and possibly amniocentesis. Amniocentesis is the sampling of amniotic fluid from your uterus to check for problems.

Additionally, many high-risk pregnancies require non-invasive diagnostics in the third trimester. These tests include a fetal non-stress test (NST) and a biophysical profile. During a NST, special belts are gently strapped around your belly to record fetal heart rate and contractions. The entire test lasts about half an hour and carries no risk to the mother or baby.

A biophysical profile combines a NST with a fetal ultrasound. Again, this test is non-invasive and poses no dangers. Both of these tests can provide invaluable information regarding pregnancy risks and your baby’s health to your OB-GYN.

Depending on your specific situation and the exact nature of any possible pregnancy complications you may face, you might also need to consult with other medical specialists and sub-specialists. These professionals can include maternal-fetal medicine specialists, medical endocrinologists, genetics specialists and others. Your OB-GYN will make any necessary referrals and help to coordinate care among your medical team.

Medications

In a high-risk pregnancy, the mother may be prescribed new medications or have additional medications added to her regimen. For example, you may need medications to control glucose levels if you have diabetes or medications for blood pressure control if you develop hypertension.

Bedrest or Activity Limitations

In some high-risk pregnancies, the mother is put on activity restrictions. These restrictions are ordered for your health and the health of your baby. According to the Mayo Clinic, complete, strict bed rest is almost never necessary. Instead, you may be limited from performing intense activity such as vigorous exercise or heavy lifting.

Cesarean Section

Even if your pregnancy is considered high-risk, you still have a very good chance of having a normal vaginal delivery. But high-risk pregnancies do have a higher likelihood of needing to be delivered by Cesarean section rather than vaginal birth. You should discuss your wishes with your OB-GYN. They will be able to tell you if a vaginal delivery is a possibility in your case, as well as explain the pros and cons of a potential C-section.

What Can You Do To Help?

The most important action you can take in the event of a high-risk pregnancy is to follow the advice of your healthcare team. Make sure to take your medications as prescribed and follow any diet or activity restrictions. Also be certain to keep all your prenatal appointments to ensure continuity of your prenatal care.

ABOUT THE CONNECTICUT OBGYN PRACTICE

Dr. John Garofalo, M.D., is an OBGYN located in Fairfield County, Connecticut, providing care for Norwalk, Darien, New Canaan, Weston, Rowaytan and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s healthcare in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

For more information, go to www.garofaloobgyn.com. John Garofalo, M.D., and Laury Berkwitt, APRN, can be reached for personal consultations by calling 203.803.1098.