High Risk Pregnancy

What is a high-risk pregnancy?

A high-risk pregnancy is one that carries a greater chance of complications affecting the mother, the baby, or both. While many pregnancies progress without major issues, some are classified as high-risk due to existing medical conditions, pregnancy-related complications, or factors that develop during the course of gestation. These pregnancies require closer monitoring, more frequent check-ups, and often the involvement of specialists in maternal-foetal medicine.

Being considered high-risk does not mean that something will definitely go wrong. In many cases, women with high-risk pregnancies deliver healthy babies without major issues. However, it does mean there are factors, either present before conception or arising during pregnancy, that could increase the likelihood of health concerns. These may relate to the mother’s general health, the baby’s development, or how the pregnancy is progressing.

High-risk pregnancies are managed with careful planning and a coordinated approach involving obstetricians, maternal-foetal medicine specialists, and other healthcare professionals when needed. With early detection, personalised care plans, and access to comprehensive monitoring tools, many potential complications can be anticipated and addressed well before they become serious.

Who is considered to have a high-risk pregnancy? 

A pregnancy is considered high-risk when the mother has specific health conditions, pregnancy-related complications, or background factors that may increase the chance of problems for her or the baby. This classification helps ensure that any potential concerns are identified early and managed with appropriate medical attention.

You may be considered to have a high-risk pregnancy if:

• You have pre-existing medical conditions — this includes chronic illnesses such as diabetes, hypertension, thyroid disease, kidney disorders, or autoimmune conditions that can affect how your body handles pregnancy.

• You are under 17 or over 35 years of age — while many women in these age groups have healthy pregnancies, the risk of certain complications tends to be slightly higher.

• You are carrying more than one baby — twins, triplets, or more place extra demands on your body and can increase the risk of preterm labour, high blood pressure, and other complications.

• You have had complications in a previous pregnancy — a history of miscarriage, stillbirth, premature birth, or caesarean delivery may lead your care team to monitor your current pregnancy more closely.

• Your current pregnancy has shown early signs of complications — some women may be reclassified as high-risk if issues such as bleeding, abnormal scans, or concerns with the baby’s growth arise during routine check-ups.

• You have certain lifestyle or social factors — this can include smoking, alcohol or substance use, poor nutrition, high stress levels, or lack of access to prenatal care.

In some cases, a woman may meet more than one of these criteria. It’s important to note that being considered high-risk is not a diagnosis, it’s a flag that you may benefit from more tailored care, closer monitoring, and sometimes specialist input. 

What causes a high-risk pregnancy? 

A pregnancy may become high-risk due to conditions that develop during its course or arise as a direct result of how the body responds to pregnancy. These causes often require early detection, more frequent monitoring, and specialist care to ensure the best possible outcome for both mother and baby.

• Preeclampsia and eclampsia — these conditions involve high blood pressure and signs of organ stress. Preeclampsia can affect the kidneys, liver, and other organs, while eclampsia includes the onset of seizures. Both can be dangerous if not managed promptly and may lead to early delivery or complications during birth.

• Gestational diabetes — poor regulation of blood sugar levels during pregnancy can impact both mother and baby. It may lead to excessive growth of the baby (macrosomia), increase the chance of caesarean delivery, and raise the baby’s future risk of metabolic problems. 

• Placental complications — problems with the placenta can disrupt the baby’s supply of oxygen and nutrients. These include placenta previa, where the placenta covers the cervix; placental abruption, where it separates from the uterus too early; and placenta accreta, where it attaches too deeply into the uterine wall.

• Intrauterine growth restriction (IUGR) — when the baby grows more slowly than expected. IUGR may be due to poor placental function or maternal health issues and is associated with a higher risk of stillbirth, early delivery, and low birth weight.

• Preterm labour — labour that begins before 37 weeks increases the risk of neonatal complications. Premature babies may face breathing difficulties, feeding problems, and developmental delays. If signs of early labour are detected, treatment may be given to delay delivery and protect the baby’s health.

• Amniotic fluid abnormalities — too much or too little fluid can signal underlying concerns. Oligohydramnios (too little fluid) may restrict foetal movement or growth, while polyhydramnios (too much fluid) can lead to preterm labour, cord problems, or complications during delivery.

• Thrombophilia and clotting disorders — abnormal clotting increases the risk of pregnancy loss and placental problems. Conditions such as antiphospholipid syndrome or inherited thrombophilias may lead to miscarriage, stillbirth, or growth restriction if not monitored and treated.

• Infections during pregnancy — some infections can directly affect the baby’s development. Certain infections, including cytomegalovirus (CMV), toxoplasmosis, listeria, and Zika virus, may cross the placenta and result in congenital defects, neurological issues, or pregnancy loss.

What are the signs and symptoms of a high-risk pregnancy?

While not all high-risk pregnancies show obvious symptoms, certain signs may indicate that closer care is needed. Some of these symptoms suggest complications that could develop into serious concerns if not addressed early. It is important to report any of the following to your doctor or midwife promptly.

• Severe abdominal pain or cramping — intense or persistent pain may point to a problem with the uterus or placenta. This could signal conditions such as placental abruption, preterm labour, or uterine rupture and should never be ignored.

• Heavy vaginal bleeding — bright red bleeding, especially with clots, may indicate a serious complication. Bleeding can be caused by placenta previa, miscarriage, or other issues and requires immediate medical assessment.

• Severe or sudden swelling — rapid swelling of the face, hands, or feet can be a sign of preeclampsia. Especially if it occurs alongside high blood pressure, headaches, or visual disturbances, it needs urgent evaluation.

• Blurred vision, dizziness, or persistent headaches — these may be symptoms of preeclampsia or elevated blood pressure. Such signs often develop gradually and should not be overlooked during pregnancy, particularly after 20 weeks.

• Pain or burning during urination — this may point to a urinary tract infection. UTIs are common in pregnancy but can lead to complications if untreated, including kidney infections and preterm labour.

• Unusual or decreased baby movements — a noticeable reduction in foetal activity after 28 weeks can be concerning. Regular movement is usually a sign of wellbeing, and any sustained change should be checked by your healthcare provider.

• High fever or chills — this could indicate an infection requiring prompt treatment. Infections during pregnancy may pose risks to the baby and should be managed early to prevent complications.

• Watery fluid leaking from the vagina — this may suggest ruptured membranes (your water breaking). If it occurs before labour has started or much earlier than expected, it may lead to preterm birth and infection risk.

While some symptoms may not always signal danger, they serve as important indicators for further investigation. Trusting your instincts and seeking medical advice when something feels off is a key part of managing a high-risk pregnancy safely.

What complications can arise due to a high-risk pregnancy?

High-risk pregnancies carry a greater chance of complications, although not every high-risk pregnancy will develop one. The goal of early detection and specialised care is to minimise these risks as much as possible. Complications can affect various stages of pregnancy and may impact the delivery or the baby’s immediate and long-term health.

• Preterm birth — babies born before 37 weeks may face breathing, feeding, or developmental challenges. Premature birth increases the risk of neonatal intensive care admission and may be associated with long-term health concerns depending on how early the birth occurs.

• Growth restriction — the baby may be smaller than expected due to placental or maternal health issues. Intrauterine growth restriction (IUGR) can result in low birth weight and may increase the risk of stillbirth or complications during delivery.

• Preeclampsia and eclampsia — these hypertensive disorders can lead to seizures, liver or kidney damage, or stroke. Preeclampsia may also affect the baby’s growth and require early delivery. If it progresses to eclampsia, it becomes a life-threatening emergency.

• Placental complications — issues such as placental abruption or placenta previa can lead to bleeding and emergency delivery. These conditions may endanger both mother and baby and may result in a caesarean or preterm delivery for safety.

• Gestational diabetes complications — poorly controlled sugar levels may result in oversized babies or stillbirth. Macrosomia (excessive foetal growth) can lead to difficult or obstructed labour, and in some cases, birth injuries or the need for surgical delivery.

• Stillbirth — in some cases, the baby may not survive the pregnancy. High-risk pregnancies, especially those involving growth restriction, uncontrolled medical conditions, or placental problems, may carry a higher risk of stillbirth.

• Postpartum haemorrhage — excessive bleeding after delivery may occur in high-risk cases. This is more likely with conditions such as placenta accreta, prolonged labour, or multiple pregnancies, and requires prompt medical management.

• Maternal complications — the mother may face long-term health effects or emergencies during childbirth. This can include organ damage, infection, blood clots, or complications from surgery, particularly in pregnancies involving pre-existing medical conditions.

How to avoid a high-risk pregnancy?

Not all high-risk pregnancies can be prevented, especially when they are caused by unavoidable medical conditions. However, there are several steps you can take to lower your chances of complications and support a healthier pregnancy outcome. 

• Attend a pre-pregnancy health check — planning ahead allows existing conditions to be optimally managed. If you have diabetes, hypertension, thyroid disorders, or other chronic illnesses, work with your doctor to ensure these are under control before conceiving.

• Start taking folic acid — this reduces the risk of neural tube defects and supports early foetal development. Ideally, begin folic acid supplementation at least one month before conception and continue through the first trimester.

• Achieve a healthy weight — being underweight or overweight can increase pregnancy-related complications. Balanced nutrition and regular physical activity can improve fertility and reduce risks such as gestational diabetes, preeclampsia, and birth complications.

• Stop smoking and avoid alcohol or drugs — these substances can directly harm the baby’s development. Quitting smoking and avoiding alcohol or recreational drug use significantly reduces the risk of miscarriage, preterm birth, and growth restriction.

• Stay up to date with vaccinations — protecting against infections is important for both mother and baby. Vaccines like rubella, influenza, and COVID-19 can help prevent infections that may complicate pregnancy or affect foetal health.

• Manage stress and prioritise rest — emotional wellbeing plays a role in physical health during pregnancy. High stress levels have been linked to poor pregnancy outcomes. Techniques such as mindfulness, prenatal yoga, or counselling can be beneficial.

• Attend all antenatal appointments — regular check-ups allow early identification of any emerging risks. Even if you feel well, attending scheduled visits ensures that any issues are caught and managed early for the best outcome.

How is a high-risk pregnancy diagnosed?

A high-risk pregnancy is typically identified during the first antenatal visit or as the pregnancy progresses through routine assessments. Diagnosis involves evaluating the mother’s medical history, current health status, and results from specific investigations that help detect potential risks early.

• Medical history and risk assessment — your first consultation includes a thorough review of past and present health. Doctors will consider your age, previous pregnancies, existing medical conditions, family history, and lifestyle factors to determine whether the pregnancy may require additional care.

• Routine blood tests and scans — standard prenatal screenings help identify developing concerns. Tests in early pregnancy assess for anaemia, infections, thyroid function, and blood sugar levels. Ultrasound scans monitor the baby’s growth, placental position, and structural development.

• Blood pressure and urine checks — regular monitoring helps detect early signs of complications. High blood pressure or protein in the urine may indicate preeclampsia or other hypertensive disorders, prompting further investigation and closer follow-up.

• Glucose tolerance test — this screening is used to detect gestational diabetes. Usually performed between 24 and 28 weeks of pregnancy, this test checks how well the body manages blood sugar and determines if dietary or medical management is needed.

• Foetal growth and wellbeing scans — extra ultrasounds may be performed to monitor the baby more closely. These are especially important in pregnancies with suspected growth restriction or reduced movements, helping guide decisions around timing and mode of delivery.

• Specialist referrals — high-risk pregnancies may be co-managed with maternal-foetal medicine or other specialists. If complex conditions are identified, you may be referred for further tests such as echocardiography, amniocentesis, or genetic screening, depending on the concern.

High-risk pregnancies are not always apparent at the start. Some develop later and are picked up through careful monitoring. That’s why regular antenatal check-ups and open communication with your care team are essential throughout your pregnancy journey.

How is a high-risk pregnancy monitored?

Monitoring a high-risk pregnancy involves closer and more structured care to reduce complications and support the health of both mother and baby. Depending on the reason for the high-risk classification, your care plan may include more frequent visits, additional tests, and the involvement of specialists.

• More frequent antenatal appointments — regular reviews help track your health and catch concerns early. Instead of monthly visits, you may need to see your doctor or obstetrician every two to three weeks, or even weekly in the later stages, to ensure everything is progressing safely.

• Detailed ultrasound scans — imaging is used to assess the baby’s growth, movements, and development. Growth scans are usually done every few weeks to check for intrauterine growth restriction (IUGR), monitor amniotic fluid levels, and examine placental position and blood flow.

• Blood pressure and urine checks — ongoing screening for signs of preeclampsia and other conditions. Raised blood pressure or protein in the urine may signal developing complications and are monitored closely throughout the pregnancy.

• Blood tests and glucose monitoring — additional tests may be needed depending on your health profile. If you have gestational diabetes or a clotting disorder, you may need regular blood tests to adjust your treatment and monitor any risks to the baby.

• Foetal wellbeing assessments — tests are done to ensure the baby is thriving in the womb. You may undergo non-stress tests (NST) or cardiotocography (CTG) to evaluate the baby’s heart rate and response to movement, especially in the third trimester.

• Specialist consultations — you may be referred to maternal-foetal medicine or other consultants. Depending on your specific condition, care may be shared between your obstetrician, endocrinologist, cardiologist, or haematologist to manage risks more effectively.

• Hospital observation or early admission — in some cases, short stays may be recommended for closer monitoring. If complications arise, such as high blood pressure or reduced foetal movements, your doctor may advise admission for continuous observation and preparation for delivery if needed.

What should I do if I have a high-risk pregnancy?

If your pregnancy is classified as high-risk, there’s a lot you can do to protect your health and your baby’s well being. The key is to stay consistent with care, follow medical guidance, and be aware of when to seek help.

• Attend all scheduled antenatal appointments

• Take medications and supplements exactly as prescribed

• Eat nutritious meals and stay well hydrated

• Get enough rest and avoid overexertion

• Follow your doctor’s advice on safe physical activity

• Monitor for warning signs like bleeding or reduced baby movements

• Have a clear birth plan discussed with your care team

• Ask for emotional support when needed and reduce stress where possible

Summary

A high-risk pregnancy means there is a greater chance of complications that could affect the health of the mother, the baby, or both. It may be due to medical conditions, pregnancy-related issues, or factors that arise during the course of pregnancy. While the term can sound alarming, many high-risk pregnancies progress safely with the right care and monitoring. 

Diagnosis usually involves reviewing medical history, regular screenings, and targeted tests. Management includes more frequent check-ups, specialist input, and a personalised care plan to ensure the best possible outcome. 

If you have been told your pregnancy is high-risk, or if you have concerns about any symptoms, schedule a consultation with Holistic Gynaecology & Fertility for detailed assessment, guidance, and care tailored to your needs.