High Risk pregnancies

Following are the factors that make a pregnancy high-risk:

• Pregnancy-related health conditions.
• Preexisting health conditions.
• Age (being over 35 or under 17 when pregnant).
• Lifestyle factors (including drug addiction, smoking, alcohol abuse and exposure to certain toxins).

Females with many pre-existing health conditions have increased health risks during their pregnancy. Following are some of these conditions:

• COVID-19.
• Autoimmune diseases, such as lupus or multiple sclerosis (MS).
• Fibroids.
• Diabetes.
• HIV/AIDS.
• High blood pressure.
• Low body weight (BMI of less than 18.5).
• Kidney disease.
• Obesity.
• Mental health disorders, such as depression.
• Polycystic ovary syndrome (PCOS).
• Thyroid disease.
• Blood clotting disorders.

Following are some pregnancy-related health conditions that can increase risks for the pregnant female and the foetus:

• Genetic conditions or birth defects in the foetus.
• Poor foetal growth.
• Multiple gestation (pregnancy with more than one foetus, such as triplets or twins).
• Gestational diabetes.
• Eclampsia and preeclampsia.
• Previous history of preterm labour or birth, or other complications with previous pregnancies.

Whether or not your pregnancy is considered high-risk, you must talk to your doctor if you notice any of the following symptoms in pregnancy:

• Chest pain.
• Abdominal pain that doesn’t go away.
• Dizziness or fainting.
• The movement of the foetus stops or slows.
• Extreme fatigue.
• Heart palpitations.
• Nausea and vomiting that’s worse than normal morning sickness.
• Severe headache that won’t go away or gets worse.
• Swelling, redness or pain in your face or limbs.
• Fever over 100.4°F.
• Trouble breathing.
• Vaginal bleeding or discharge.
• Thoughts about harming yourself or the foetus.

Females who get pregnant for the first time after 35 years of age experience high-risk pregnancies. Research has proven that they’re more susceptible to developing complications than younger people are. They may include pregnancy-related health conditions like gestational diabetes and early pregnancy loss.

Younger people below the age of 17 years can also experience high-risk pregnancies due to:

• Less likely to get thorough prenatal care.
• Anaemic.
• Unaware they have sexually transmitted infections (STIs).
• More likely to have premature labour or birth.

High-risk pregnancies can be life-threatening for the foetus as well as the pregnant female. The potential serious complications may include:

• Eclampsia (seizure from pregnancy).
• Preeclampsia (high blood pressure from pregnancy).
• Caesarean delivery (C-section).
• Preterm delivery.
• Low or high birth weight.
• Excessive bleeding during labour and delivery, or after birth.
• Problems with the brain development of the foetus.
• Birth defects.
• Neonatal intensive care unit admission for your baby.
• Miscarriage.
• Stillbirth.
• Intensive care unit admission for you.

Getting early and thorough access to prenatal care is very important for women experiencing high-risk pregnancies. You must tell your doctor about your past pregnancies and health history. If your pregnancy falls in the high-risk category, you may require special monitoring throughout your pregnancy. Following are the tests that may be performed to monitor your health and the health of the foetus:

• Ultrasonography
  This test employs sound waves to produce images of the foetus to screen for congenital conditions.
• Blood and urine testing
  To check for certain congenital conditions or genetic diseases.

Continuous monitoring to ensure that the foetus gets enough oxygen, getting biophysical profile checks that monitor their movements, breathing, and amniotic fluid with the help of a non-stress test and ultrasound which monitors their heart rate.

The management of high-risk pregnancies depends on certain risk factors, including:

• Consultation with a maternal foetal medicine (high-risk pregnancy) specialist.
• Closer follow-up with your obstetrician.
• More ultrasounds and closer foetal evaluation.
• Consultation with other medical specialists.
• Careful monitoring of medications used to manage pre existing conditions.
• Home blood pressure monitoring.

If your health or the health of the foetus is at stake, your healthcare provider may recommend a C-section or induction of labor.

The complications of pregnancy can be reduced by:

• Identifying potential health risks before getting pregnant.
• Avoiding alcohol and drugs.
• You must let your doctor know about your personal and family medical history.
• Managing any preexisting medical conditions that you may have.
• Quitting smoking.
• Making sure any medications you are taking for the long-term are safe to be used during pregnancy.
• Practising safe sex habits.
• Planning pregnancies between 18-34 years of age.

Whether you know beforehand that you have a high risk pregnancy or you simply want to be careful and take some steps to prevent having a high-risk pregnancy, you must stick to the basics, which include:

• Schedule an appointment prior to conception
  If you are thinking of getting pregnant, you must talk to your doctor about it. He will counsel you about the prenatal vitamins and folic acid you need to take during pregnancy. He will also counsel you about the healthy weight you must maintain before you get pregnant. If you are suffering from a medical condition, your medication doses may be adjusted to prepare you for the pregnancy. Your doctor might also discuss the risk of having a baby with a genetic condition for you.
• Seek regular care during pregnancy
  Attending regular prenatal visits to your doctor is beneficial as he will monitor your health and the health of your baby. You might even be referred to a specialist in genetics, maternal-foetal medicine, or paediatrics.
• Avoid risky substances
  If you take alcohol or illegal drugs, quit those. If you are a smoker, quit smoking. Discuss with your doctor about any supplements or medications you are currently taking.

Many females with high-risk pregnancies don’t face any problems during their pregnancies and deliver healthy babies. However, they may be susceptible to developing health problems in the future that may include:

• Postpartum depression.
• Complications during future pregnancies.
• High blood pressure.
• Type 2 diabetes.
• Stroke.
• Cardiovascular disease.

Certain high-risk pregnancies can enhance a child’s risk of:

• Breathing disorders.
• Behavioural problems.
• Growth and developmental delays.
• Mental health conditions.
• Gastrointestinal diseases.
• Obesity and diabetes.
• Neurological disorders.
• Hearing, vision or dental problems.

Depending on your overall condition, your doctor might recommend:

• Targeted or specialised ultrasound
  This is a type of foetal ultrasound that employs high-frequency sound waves to create images of the foetus in the uterus. It targets suspected problems like atypical developmental problems.
• Prenatal cell-free DNA (cfDNA) screening
  During this procedure, the mother’s DNA and that of the foetus is screened to look for chromosomal abnormalities.
• Invasive genetic screening
  Your doctor might recommend chorionic villus sampling (CVS) or amniocentesis. During amniocentesis, a fluid sample surrounding and protecting a baby during pregnancy is taken from the foetus. It is usually performed after 15 weeks of pregnancy and is used to identify some types of genetic conditions and serious conditions of the brain or the spinal cord.
• During CVS, a cell sample is taken from the placenta. This test is typically performed between 10-12 weeks of pregnancy and it is used to look for certain genetic problems.
• Ultrasound for cervical length
  Your doctor may suggest you to go for an ultrasound to measure the cervical length at prenatal appointments to determine if you are susceptible to developing preterm labour.
• Laboratory tests
  Your doctor will test your urine to look for urinary tract infections and infectious diseases like syphilis and HIV.
• Biophysical profile
  This prenatal ultrasound is used to determine the well-being of the baby. It might involve a USG to assess foetal wellbeing or also foetal heart rate monitoring, depending on the results of the ultrasound.