Pregnancy is a time of great joy, anticipation and excitement. But for some women, pregnancies are ‘high-risk’, where the health of the mother and baby, in gestation and post-delivery remains a concern. In such cases, extra care is needed to maintain 40-42 weeks of gestation and proper post-natal care.
According to a 2017 study, 20% to 30% cases in India belong to high-risk pregnancy category; which is responsible for 75% of perinatal morbidity and mortality. Early detection and effective management can substantially reduce the cases of negative outcomes.
Today, modern obstetric science has advanced diagnostic tools and protocols to successfully navigate through such cases. Proper understanding of risk factors is essential for couples who are either planning for a pregnancy or expecting a child.
Risk Factors for High Risk Pregnancy
A pregnancy can be complicated by one or many factors, which can cause adverse outcomes. Here are some common factors associated:
- Maternal Age– Women above the age of 35 are more at risk of developing complications like gestational diabetes, genetic birth defects, preeclampsia, pre-term labor and stillbirth. The risk of miscarriage increases after age of 40. This holds true for women under 17 years of age as well.
- Pre-existing Health Conditions – Health conditions like diabetes,autoimmune diseases, kidney aliments, depression, cardio-vascular diseases, HIV positive, hypertension and high blood pressure makes pregnancies complicated.
- Obesity or Underweight- Moderately obese women have 11% higher chances of having a child with heart defects, and significantly obese women have 33% higher chances of the same, according to National Institutes of Health. Obesity also increases the chance of gestational diabetes, preeclampsia and caesarian delivery. Similarly, women with a low BMI index can have increased chances of delivering babies with low birth weight, premature delivery and developmental defects.
- Multiple Pregnancies – Technically, a woman can have a healthy pregnancy with twins and triplets, but there is always a risk of complication. They have been found to have increased chances of pre-term deliveries.
- RH Incompatibility- When a mother with Rh-negative blood type is exposed to Rh-positive blood of fetus (inherited from father), her body produces antibodies. But these Rh antibodies are not problematic till second pregnancy, in which case the Rh antibodies consider the fetal blood cells as foreign. This can lead to hemolytic anemia in the baby and in some cases can cause miscarriage.
- Structural Issues in Reproductive Organs- Short cervical length has been found to increase risks of miscarriages and pre-term labor. This is called cervical insufficiency. Vaginal infections, double uterus, uterine fibroids and intrauterine growth restrictions are also risky for the baby. Another issue is placenta previa. This is a condition where the placenta is low placed inside the uterus, such that it wholly or partially blocks the opening of uterus. This condition has been associated with bleeding in early pregnancy and greater chances of having a cesarean section.
Along with these factors, previous history of miscarriages, pre-term labor and children with chromosomal abnormalities increase chances of a high-risk pregnancy.
Managing High Risk Pregnancies
Most of these conditions are managed by doctors through medications, blood tests and regular pre-natal check-ups. Through obstetric ultrasounds, the baby’s development and position can be monitored. Women are advised to maintain a healthy lifestyle during pregnancy, which includes a balanced diet, avoiding alcohol and smoking, taking pre-natal vitamins and regular exercise. Those with diabetes need to monitor and control blood-glucose levels.
Getting proper immunizations also prevent the risk of developing viral infections. Sometimes gynecologists may also refer women to fetal medicine specialists, if the baby is suspected to have genetic abnormalities. The key is to find the best possible doctors, nurses and healthcare professionals to ensure the best outcome for your pregnancy.