What to expect with a high-risk pregnancy

Pregnancy can be a time filled with joy and excitement, but it can also be a time of worry and stress, especially for women with high-risk pregnancies. These cases demand special attention and monitoring from doctors who specialize in helping families navigate even the most challenging pregnancies.

Due to the complexity of a high-risk pregnancy, a team of doctors may be needed to care for some expecting mothers. Part of that team includes a maternal fetal medical specialist, also known as a perinatologist — a doctor who specializes in complicated pregnancies, usually characterized by maternal medical problems, a history of prenatal complications or fetal abnormalities.

Dr. Kristin Williams, a perinatologist affiliated with Sharp Grossmont Hospital, says, “There are many reasons why a pregnancy may be considered high-risk, but in the majority of cases, a perinatologist consults and/or co-manages the pregnancy with the patient's general obstetrician.” Each case presents its own unique challenges requiring increased medical attention when compared to a typical pregnancy.

A pregnancy may be considered high-risk if the woman is experiencing conditions such as:

• Hypertension

• Diabetes

• Advanced maternal age (35 years or older)

• Prior preterm births

• Multiple gestations (twins or multiples)

Maternal diabetes
People living with diabetes are no strangers to daily health monitoring, but it is even more important with a baby on the way. A mother's high blood glucose levels increase the likelihood of birth defects, preterm births and even potential loss of the pregnancy.

Changes in hormones during pregnancy affect glucose levels, so women will likely need to adjust their diet and daily exercise routines per their doctor's recommendations.

Diabetes can also increase risk of preeclampsia, a condition characterized by high blood pressure, which is often detected by high levels of protein in the urine of the mother. This can be life-threatening to the mother and baby. Preeclampsia requires treatment and possible admission to the hospital, and often results in the delivery of the baby (preterm, if need be).

Hypertension
Although a woman can have high blood pressure prior to becoming pregnant, some women develop gestational hypertension after becoming pregnant. Whether the condition was pre-existing or developed during pregnancy, hypertension can lead to a low birthweight, preterm birth, worsening diseases such as preeclampsia, and an increased likelihood of the mother developing cardiovascular disease later in life.

Anyone who has been diagnosed with hypertension and is pregnant or planning to become pregnant should visit their primary care doctor to be prescribed a pregnancy-safe medicine. An obstetrician may consult with a perinatologist who would work with their patient to develop a plan of care involving frequent monitoring to ensure the health of both mother and baby.

Advanced maternal age
While having a child after age 35 is becoming increasingly common, it is still not without its challenges. Concerns may include a higher likelihood for fetal chromosomal abnormalities, gestational hypertension, preeclampsia, gestational diabetes and preterm birth due to preterm labor. Due to these complications, women who are age 35 or older are advised to seek the care of a perinatologist either for consultation or co-management of their pregnancy, especially if they have any of the above mentioned conditions.

Multiple gestations
Complications from multiple gestations include preterm labor, preterm birth, fetal growth issues, diabetes and hypertension. A large number of multiple gestations are delivered preterm (before 37 weeks gestation) and delivery via C-section is more common.

Preterm birth
A preterm birth can occur whether or not a patient is considered at risk for preterm labor and delivery. Physical causes include a short cervix, young maternal age or advanced maternal age, and a short interval pregnancy (becoming pregnant shortly after giving birth).

Women who have a history of delivering preterm are more likely to have subsequent preterm births. There are also many lifestyle and environmental factors that may increase the likelihood of a preterm birth. These include use of alcohol and drugs, physical trauma and a stressful home environment.

If risk factors for preterm birth are a concern, a perinatologist may work with the obstetrician to provide the patient with additional ultrasounds, monitoring and possibly medications to help prevent the onset of preterm labor and delivery.

Care and hope
It can be scary being told your pregnancy is high-risk, but with early testing and detection of risk factors and symptoms, the obstetrician and perinatologist can develop the best strategy possible for each patient in hopes of a successful pregnancy and delivery.

Dr. Williams recommends leading a healthy and active lifestyle before, during and after pregnancy. She also encourages parents with any genetic or familial risk factors that may affect the baby to see a genetic counselor early on. The most important thing, Dr. Williams says, is to develop and maintain a good community of support to help the expecting mother through the demands of any pregnancy and specifically a high-risk pregnancy.

Though analyzing test results are a large part of what a perinatologist does, they often go beyond the charts and numbers, working with their patients holistically. “I love partnering with my patients — getting to know them as people, their obstacles and their concerns — to create the best plan of care for mom and baby,” says Dr. Williams.