High-Risk Pregnancy: An Overview of What Can Go Wrong and How High-Quality Obstetric Care Can Help
Pregnancy can be a joyful experience as families await the birth of a child, but that isn’t always the case. A wide range of factors, from already-existing health conditions to lifestyle choices and more, can put a woman at risk for complications during pregnancy, all the way from the first trimester to labor and delivery.
In what follows, Dr. Julianne Lauring, an Assistant Attending Obstetrician and Gynecologist and Assistant Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medicine, provides an overview of the risk factors that may turn a pregnancy from joyful to challenging. She also discusses what a woman can do to stay healthy before and during pregnancy.
What are the most common health conditions that make a pregnancy high-risk?
These include high blood pressure, diabetes (type 1 or 2), obesity and mental health disorders.
High blood pressure
High blood pressure (hypertension) outside of pregnancy may increase your risk for pre-eclampsia, a dangerous condition that can affect your kidneys, liver and platelet count. Pre-eclampsia tends to show up after 20 weeks but even more commonly toward the end of the third trimester.
Pre-eclampsia also affects the way the baby grows in utero and increases the likelihood of premature delivery and even stillbirth. Its symptoms include high blood pressure, excess protein in your urine, vision changes and headache, among others.
Diabetes
Both type 1 and type 2 diabetes, if uncontrolled, lead to similar complications as those mentioned above. That also goes for gestational diabetes, a temporary form of the disease experienced in some pregnancies—usually in the third trimester. In pregnant mothers with uncontrolled blood sugar levels, the fetus may grow very large.
Obesity
Obesity, defined as having a BMI of 30 and up, increases the above-mentioned risks as well, especially to the developing fetus. Obesity is linked to high blood pressure and a variety of other medical disorders.
The good news, says Dr. Lauring, is that all of these can be controlled via:
- Medication, including insulin for diabetes
- Periodic ultrasounds to see how the fetus is developing
- Close monitoring and follow-up
What is the difference between pre-eclampsia and eclampsia?
When a woman with pre-eclampsia has seizures, it’s diagnosed as eclampsia. Eclampsia typically occurs around the time a woman gives birth, but it can happen to women with pre-eclampsia as well, or even before a diagnosis of pre-eclampsia. In that case, eclampsia can be the first sign that something is wrong.
Both conditions are considered serious and even potentially life-threatening.
How might a woman’s age affect pregnancy?
Older maternal age—over 35—is an independent risk factor for pregnancy complications, including:
- High blood pressure
- Stillbirth
- Genetic abnormalities and miscarriages (the two are linked)
- Babies who don’t grow well during pregnancy
Young age can pose a number of dangers as well. According to the World Health Organization (WHO), adolescent mothers aged 10 to 19 face higher risks of eclampsia, puerperal endometritis—an infection of the lining of the uterus after giving birth—and systemic infections compared to women in their early 20s. Babies of adolescent mothers may be prone to low birth weight, preterm birth and severe neonatal conditions.
What is the impact of substance use on pregnancy?
Tobacco and alcohol are to be avoided, Dr. Lauring says, and so are addictive drugs, from painkillers to illegal substances. “Some people use more than one substance, so it can be hard to tease out which one is responsible for putting a pregnant woman in harm’s way. Medical and socio-economic factors also are associated with substance use. Hopeful mothers-to-be should seek help with any substance issues—preferably before she gets pregnant.”
What if she’s expecting “multiples”—twins, triplets or more?
The more babies, the more possible complications, she says. “The risk of premature birth at 35 to 36 weeks increases when a woman is expecting more than one baby. (A normal pregnancy typically lasts 40 weeks.) As well, multiples increase the risk of all the conditions and complications referred to above, such as diabetes, pre-eclampsia and stillbirth.
If a woman has had a previous preterm birth, does that increase her risk of having another?
The short answer is “yes.” But unlike a pregnant woman’s existing medical conditions, for which treatments are available, there are limited treatment options for preventing preterm birth. “We used to prescribe a progesterone-based medication, but it was pulled from the market in April 2023,” says Dr. Lauring. “What we can do is monitor the cervix. If we see that it’s shortening—getting ready for labor—we can place a stitch to keep it closed. Some obstetricians are using vaginal progesterone to achieve a similar effect, but we aren’t sure how effective it is.”
What can a woman do before getting pregnant?
First, Dr. Lauring advises, a woman trying to get pregnant should talk to her primary care physician about managing any medical conditions, from diabetes to obesity and high blood pressure. “She should ask whether to continue taking her usual medications when she gets pregnant. And she should make sure her vaccines are all up-to-date, as some can’t be administered during pregnancy.
“Women with obesity or mental health challenges should work with their primary care provider to optimize their weight and mental health as much as possible,” she adds.
During pregnancy?
Pregnant women are advised to seek prenatal care as soon as they’ve confirmed that they’re pregnant and work with their doctors to control any chronic conditions. “A folic acid supplement—also known as vitamin B9—is also par for the course during pregnancy,” says Dr. Lauring.
“There’s a lot of watching—i.e., surveillance—in obstetrics,” she says. “Using a variety of tests, we can keep tabs on anything that may turn a normal pregnancy into a high-risk one. We also work collaboratively with the genetic counseling team along with our colleagues in pediatrics at Weill Cornell Medicine, and with the NICU—the neonatal intensive care unit at NewYork-Presbyterian Hospital.
Takeaway points
During pregnancy, women are advised to:
- seek prenatal care
- work with their primary care provider to optimize their weight and mental health, and to control any existing health conditions such as diabetes and high blood pressure
- avoid using substances, including tobacco, alcohol and addictive or illegal drugs
- make sure to be current with their vaccines
- take a folic acid supplement…
- …and take care of themselves. That means eating well, sleeping well, managing stress and seeking love and support from friends and loved ones.
Make an appointment with an obstetrician specializing in high-risk pregnancy here.