Your guide to high-risk pregnancy


by Lori Atkins, MD

Jan 29, 2020

Nearly every week, I have a patient ask me if they are a “high-risk pregnancy.” Most are fairly concerned if they think the fall into the high risk category, and rightfully so — there are some additional things we need to consider if certain risk factors are at play.

But what is a high-risk pregnancy?

At the heart of it, I would say that all pregnancies have the potential to become high risk but overall, those risks are varied. Thankfully, most pregnancies are relatively uncomplicated, so my first word of advice is to take a deep breath and relax!

It’s important to know about these risk factors, but it’s also important to realize that they do not affect the majority of women. This information is not intended to cause you stress. In fact, just the opposite — as an OB/GYN, my goal is to empower you to ask the right questions of your doctor so you can work together for a happy, healthy pregnancy.

Related: Taking care of your body before your first pregnancy

Who qualifies as “high risk?”

There are some risk factors that are present during your entire pregnancy. These pregnancies require detailed evaluations, close monitoring and often early delivery. We will often consult with specialists to assist in your care if you have one of the following conditions:

  • Pre-existing medical conditions: These include preexisting medical conditions like thyroid disease, hypertension, diabetes, autoimmune conditions and many more. Ask your OB/GYN if this applies to you.
  • Prior pregnancy complications: We consider any woman who has lost pregnancy in the third trimester at high risk.
  • Multiples: When you carry twins or triplets, we will be doing a lot of sonograms to check the health and growth of each baby. Pregnancies growing more than one baby will get a lot of attention (lucky you!) and often a perinatologist (also called maternal-fetal medicine specialist) is involved.

Women who have a baseline medical issue will likely have more frequent appointments and sonograms. One thing to consider if you do have a pregnancy that is deemed “high risk” is that you are more likely to have a planned, induced labor or delivery by cesarean section (C-section) before your due date. Of course, this is not always the case — every pregnancy is unique!

How risks change throughout your pregnancy

When we think about the potential risks of pregnancy, it’s helpful to break it down by trimester because our risk assessment varies as you move through your pregnancy. Here’s what to expect in each phase of pregnancy.

First trimester

Congrats, you’re pregnant! Part of your overall risk evaluation in trimester one could involve frequent blood work and sonograms to check your baby’s progress and monitor your ongoing health.

Other than loss of pregnancy, a few other risks can come into play early on in your pregnancy. Nausea and vomiting are common and usually mild, but can occasionally develop into more serious conditions. If you are experiencing severe nausea and vomiting, talk to your OB/GYN for guidance.

There are also age-related risks that bear out in the first trimester, such as an increased risk for having a baby with an abnormal chromosome count. This can be discovered at this time through testing.

Related: Waiting later in life to have a baby

Second trimester

Around 20 weeks, we perform your anatomy ultrasound, which hopefully will show a healthy little growing baby. During your second trimester, we’ll also monitor your cervix measurements and watch out for signs of preterm labor. If anything concerning is found, or sometimes based on your history, you might anticipate more frequent doctor’s visits and testing.

But you can count on your OB/GYN to be by your side through it all. If we see anything that may affect you or your baby during an ultrasound, we will often get input from a perinatologist, an obstetrician specifically trained in high-risk pregnancy care. Sometimes, even a pediatric specialist can help manage a variety of scenarios.

Third trimester

You’re two-thirds of the way there now! You’ll continue to have regular touchpoints and ultrasounds to monitor your health and your baby’s health as you approach your due date.

The third trimester can involve risks such as preterm labor, but it also can involve risks to your health that may cause us to deliver early. These conditions include gestational diabetes, preeclampsia or other conditions associated with elevated blood pressure, HELLP (hypertension, elevated liver enzymes, low platelets), fetal growth abnormalities, placental abnormalities (like low lying placenta or placenta previa), and complications related to previous uterine surgeries.

These conditions require more frequent appointments and testing to make sure your baby is being properly grown and nourished by the placenta. Sometimes, hospitalization or early delivery can be the best option. These conditions are often managed with the consultation of a perinatologist.

How you can help manage your pregnancy risks

As you can see, pregnancy can be affected by a variety of factors. But let me remind you again, do not stress. Preparing to bring a baby into the world is an exciting, joyful time. Remember that most pregnancies do go smoothly and without complications. Don’t let any potential worries overshadow your joy!

If you’re worried, these are the best things you can do as an expectant mom:

  • Make sure your doctor knows your complete medical history and current health.
  • Be open with any and all symptoms you may be experiencing, as well as potential concerns, even those that seem minor.

During your pregnancy, your OB/GYN will work with you to asses your risks, recommend personalized care and answer all your questions until you feel confident in your health and that of your baby.

And also remember this: as OB/GYNs, our primary goal is for you to have a happy, healthy pregnancy and a happy, healthy baby!

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About the Author

Lori Atkins, MD, is an obstetrician-gynecologist (OB/GYN) on the medical staff at Baylor Scott & White All Saints Medical Center – Fort Worth.

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