High-risk pregnancy

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A high-risk pregnancy is a pregnancy where the mother or the fetus has an increased risk of adverse outcomes compared to uncomplicated pregnancies. No concrete guidelines currently exist for distinguishing “high-risk” pregnancies from “low-risk” pregnancies; however, there are certain studied conditions that have been shown to put the mother or fetus at a higher risk of poor outcomes.[1] These conditions can be classified into three main categories: health problems in the mother that occur before she becomes pregnant, health problems in the mother that occur during pregnancy, and certain health conditions with the fetus.[2]

High-risk pregnancy
Ultrasound during Pregnancy
Ultrasound during pregnancy
SpecialtyObstetrics, midwifery
Risk factorsHigh blood pressure, diabetes, heart disease, renal disease, autoimmune disease, fetal growth restriction, multiple gestations, congenital fetal abnormalities
Diagnostic methodBased on symptoms, imaging, screening

In 2012, the CDC estimated that there are approximately 65,000 pregnancies deemed "high-risk" in the United States each year.[3]

Causes

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Source:[4]

Pregnancies may be considered high-risk if the mother has certain pre-existing health conditions. These include:

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In some pregnancies, certain conditions that arise in the developing fetus or fetuses can put a pregnancy into a high-risk category. In these situations, special care must be taken during the pregnancy to address these factors while the fetus is still in the womb to reduce the chances of morbidity and mortality. Common fetal-related factors that can create a high-risk pregnancy include:

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Other reasons a pregnancy may be classified as high-risk include if the mother develops a medical condition during pregnancy or if complications occur during pregnancy.

  • Conditions developed during pregnancy:
    • Pre-eclampsia: Pre-eclampsia is a syndrome marked by a sudden increase in the blood pressure of a pregnant woman after the 20th week of pregnancy. It can affect the mother's kidneys, liver, and brain. When left untreated, the condition can be fatal for the mother and/or the fetus and result in long-term health problems.[16]
    • Eclampsia: Eclampsia is a more severe form of preeclampsia, marked by seizures and coma in the mother.[6][17]
    • HELLP Syndrome[18]
    • Gestational diabetes: Gestational diabetes (GDM) is diabetes that first develops when a woman is pregnant. Many women can have healthy pregnancies if they manage their diabetes, following a diet and treatment plan from their health care provider. Uncontrolled gestational diabetes increases the risk for adverse perinatal outcomes such as preterm labor and delivery, preeclampsia, and other hypertension-related conditions in pregnancy. Additionally, some evidence suggests that GDM is associated with long-term outcomes such as development of type 2 diabetes in the mother and future obesity in the infant.[19][20][21]
  • Timing of pregnancy:
  • Placenta - The placenta is a structure within the uterus that facilitates exchange of nutrients, oxygen, and waste products between the mother and the fetus. When this connection between mother and fetus is abnormally positioned, the pregnancy is more complicated and requires careful delivery technique.
  • Infections - Different types of infections may be spread from mother to fetus, predisposing adverse pregnancy outcomes. An existing infection in the mother may be passed along to the fetus during pregnancy through the placenta. A newborn infant is also directly exposed to pathogens during delivery through the vaginal canal or breastfeeding. Fetal infections that develop during pregnancy may trigger spontaneous abortion or affect typical fetal growth and development.[31] Several infections that are notably associated with pregnancy include Group B streptococcus,[32] Bacterial vaginosis,[33] yeast infections,[34] and Zika virus.[35] Some of these infections may be rare but are associated with significant infant morbidity and mortality, particularly if the infection spreads throughout the fetal nervous system. Early evidence shows that COVID-19 maternal infection in pregnancy may increase adverse outcomes such as preeclampsia.[36][37]
  • Twin-to-twin transfusion syndrome[38]

Management

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Management of high-risk pregnancy is dependent on the specific etiology and situation of each particular pregnancy. Some examples of management for certain conditions include:

Anxiety surrounding "high-risk pregnancy" label

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The concept of a high-risk pregnancy has been shown to elicit a strong emotional response in some pregnant women, including fear, anger, and guilt.[50] In addition, some studies show that a pregnancy labeled "high-risk" may lead to more unnecessary testing than without the label, increasing these fears and reducing the pregnant woman's sense of control over the situation.[51] Managing anxiety in pregnancies deemed high-risk has been deemed an important focus in research, although there is currently limited high-quality studies on the issue.[52]

References

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