Navigating the high-risk pregnancy

FOR most women, their pregnancies, outside of the usual symptoms such as morning sickness and some achiness, are uneventful. For other women, however, obstetrician gynaecologist Dr Robyn Khemlani says that their pre-existing conditions and/or other conditions developed during the course of their pregnancies may cause life-threatening complications for them and their unborn children.

“A high-risk pregnancy is one that threatens the health or life of the mother or her foetus. It often requires specialised care from specially trained providers. Some pregnancies become a high risk as they progress, while some women are at increased risk for complications even before they get pregnant for a variety of reasons,” Dr Khemlani said.

On the bright side, she reasons that with early and regular prenatal care many women who are classified as high-risk go on to have healthy pregnancies and deliveries without complications.

But what specific factors that could create a high-risk pregnancy situation? Dr Khemlani says that outside of some pre-existing health conditions, other factors such as age, lifestyle and sexual health issues would matter.

Below, she outlines how some of these factors may affect the health of a woman’s pregnancy.

Pre-existing high blood pressure

Uncontrolled high blood pressure can damage the mother’s kidneys and increase the risk for low birth weight or pre-eclampsia.

“It is very important for women to have their blood pressure checked at every prenatal visit so that health care providers can detect any changes and make decisions about treatment,” Dr Khemlani advised.

Pre-existing diabetes

“It is important for women with diabetes to manage their blood sugar levels both before getting pregnant and throughout pregnancy,” Dr Khemlani said.

She explained that this is particularly important because during the first few weeks of pregnancy, even before a woman knows she is pregnant, high blood sugar levels can cause birth defects. Also, she says that another reason for women with diabetes to keep tight control of their blood sugar is because babies of mothers with diabetes tend to be large and are likely to have low blood sugar soon after birth.

Autoimmune disease

Conditions such as lupus and multiple sclerosis can increase a woman’s risk for problems during pregnancy and delivery.

“For example, women with lupus are at increased risk for pre-term birth and stillbirth. Interestingly, some women may find that their symptoms improve during pregnancy, while others have flare-ups and other challenges,” Dr Khemlani said. Also, she said treatment for some of these diseases also carry additional risks for the foetus.

“Certain medicines used to treat autoimmune diseases may be harmful to the foetus, meaning a woman with an autoimmune disease will need to work closely with a health care provider throughout pregnancy,” Dr Khemlani explained.

Overweight and obesity

Obesity increases the risk for high blood pressure, pre-eclampsia, gestational diabetes, stillbirth, neural tube defects, and caesarean delivery.

Multiple births

The risk of complications is higher in women carrying more than one foetus (twins and higher-order multiples). Common complications include pre-eclampsia, premature labour and preterm birth. More than one-half of all twins and as many as 93 per cent of triplets are born at less than 37 weeks gestation.

Young age

Pregnant teens are more likely to develop pregnancy-related high blood pressure and anaemia (lack of healthy red blood cells) and to go through preterm (early) labour and delivery than older women.

“Teens are also more likely to not know they have a sexually transmitted infection (STI). Some STIs can cause problems with the pregnancy or for the baby. Teens may be less likely to get prenatal care or to keep prenatal appointments,” Dr Khemlani explained.

Prenatal care, she says, is important because it allows a health care provider to evaluate, identify and treat risks, such as counselling teens not to take certain medications during pregnancy, sometimes before these risks become problems.

First-time pregnancy after age 35

Most older first-time mothers have normal pregnancies, but research shows that older women are at higher risk for certain problems than younger women. “Some pregnancy-related complications that are often seen in women over 35 are high blood pressure (called gestational hypertension) and diabetes (called gestational diabetes), pregnancy loss, caesarean (surgical) delivery. Delivery complications may include excessive bleeding, prolonged labour and genetic disorders such as Down syndrome in the baby,” Dr Khemlani advised.

Alcohol use

Drinking alcohol during pregnancy can increase the baby’s risk for foetal alcohol spectrum disorders (FASDs), sudden infant death syndrome and other problems.

“FASDs have a variety of effects on the foetus that result from the mother’s drinking alcohol during pregnancy. The effects range from mild to severe and they include intellectual and developmental disabilities, behaviour problems, abnormal facial features and disorders of the heart, kidneys, bones and hearing,” Dr Khemlani outlined.

Fortunately, FASDs are completely preventable. All that is required is for a woman to refrain from consuming alcohol while she is pregnant. Women who drink during pregnancy are also at an increased risk of miscarriage and stillbirth. Currently, research shows that there is no safe amount of alcohol to drink while pregnant.

Tobacco use

Smoking during pregnancy puts the foetus at risk for preterm birth, certain birth defects and sudden infant death syndrome (SIDS).

“Research has also found that smoking during pregnancy leads to changes in an infant’s immune system. Second-hand smoke also puts a woman and her developing foetus at increased risk for health problems,” Dr Khemlani shared.

Prior surgery

A history of surgery on your uterus, including multiple C-sections, multiple abdominal surgeries, or surgery for uterine fibroids, according to Dr Khemlani, may also increase your pregnancy risks.

Women who have been classified as high risk should receive care from a special team of health care providers to ensure the best possible outcomes.