High-Risk Pregnancy

What is a high-risk pregnancy?

A high-risk pregnancy is one that threatens the health or life of the mother or her fetus.

Several factors can make a pregnancy high risk, including existing health conditions, the mother’s age, lifestyle, and health issues that happen before or during pregnancy.

Existing health conditions

·         High blood pressure :

Even though high blood pressure can be risky for mother and fetus, many women with high blood pressure have healthy pregnancies and healthy children. Uncontrolled high blood pressure, however, can lead to damage to the mother’s kidneys and increases the risk for low birth weight or preeclampsia.

·         Diabetes:

It is important for women with diabetes to manage their blood sugar levels before getting pregnant. High blood sugar levels can cause birth defects during the first few weeks of pregnancy, often before women even know they are pregnant. Controlling blood sugar levels and taking a multivitamin with 40 micrograms of folic acid every day can help reduce this risk

·         Kidney disease:

Women with kidney disease often have difficulty getting pregnant, and any pregnancy is at significant risk for miscarriage. Pregnant women with kidney disease require additional treatments, changes in diet and medication, and frequent visits to their health care provider.

·         Autoimmune disease:

Autoimmune diseases include conditions such as lupus and multiple sclerosis. Some autoimmune diseases can increase a women's risk for problems during pregnancy. For example, lupus can increase the risk for preterm birth and stillbirth. Some women may find that their symptoms improve during pregnancy, while others experience flare ups and other challenges. Certain medications to treat autoimmune diseases may be harmful to the fetus as well.

·         Thyroid disease

The thyroid is a small gland in the neck that makes hormones that help control heart rate and blood pressure. Uncontrolled thyroid disease, such as an overactive or underactive thyroid, can cause problems for the fetus, such as heart failure, poor weight gain, and brain development problems. Thyroid problems are usually treatable with medicine or surgery. However, a recent NICHD-supported study found that treating mildly low thyroid function during pregnancy did not improve outcomes for mothers or their babies.

·         Obesity

Obesity can make a pregnancy more difficult, increasing a woman’s chance of developing diabetes during pregnancy, which can contribute to difficult births. On the other hand, some women weigh too little for their own health and the health of their growing fetus. In 2009, the Institute of Medicine updated its recommendations on how much weight to gain during pregnancy. New recommendations issued by the American College of Obstetricians and Gynecologists suggest that overweight and obese women may be able to gain even less than what is recommended and still have a healthy infant.

·         HIV/AIDS

HIV/AIDS damages cells of the immune system, making it difficult to fight infections and certain cancers. Women can pass the virus to their fetus during pregnancy; transmission also can occur during labor and giving birth or through breastfeeding. Fortunately, effective treatments exist to reduce the spread of HIV from the mother to her fetus, newborn, or infant. Women with very low viral loads may be able to have a vaginal delivery with a low risk of transmission. An option for pregnant women with higher viral loads (measurement of the amount of active HIV in the blood) is a caesarean delivery, which reduces the risk of passing HIV to the infant during labor and delivery. Early and regular prenatal care is important. Women who take medication to treat their HIV and have a cesarean delivery can reduce the risk of transmission to 2%

·         Zika infection:

Although scientists and healthcare providers have known about Zika for decades, the link between Zika infection during pregnancy and pregnancy risks and birth defects has only recently come to light. NICHD-supported research has shown that infants born to mothers who were infected with Zika just before and during pregnancy were at higher risk for different problems with the brain and nervous system. The most noticeable is microcephaly, a condition in which the head is smaller than normal. Zika infection during pregnancy can also increase the woman’s risk for pregnancy loss and stillbirth. Researchers are still just learning the possible mechanisms of Zika’s effects on pregnancy.

The mother’s age :

Young age :  Pregnant teens are more likely to develop pregnancy-related high blood pressure and anemia (lack of healthy red blood cells) and to go through preterm (early) labor and delivery than women who are older. 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. Prenatal care is important because it allows a healthcare provider to evaluate, identify, and treat risks, such as counseling 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, including:

·         Pregnancy-related high blood pressure (called gestational hypertension) and diabetes (called gestational diabetes)
·         Pregnancy loss
·         Ectopic pregnancy (when the embryo attaches itself outside the uterus), a condition that can be life-threatening
·         Cesarean (surgical) delivery
·         Delivery complications, such as excessive bleeding
·         Prolonged labor (lasting more than 20 hours)
·         Labor that does not advance
·         Genetic disorders, such as Down syndrome, in the baby

Lifestyle:

Alcohol use

Alcohol consumed during pregnancy passes directly to the fetus through the umbilical cord. The Centers for Disease Control and Prevention recommend that women avoid alcoholic beverages during pregnancy or when they are trying to get pregnant. During pregnancy, women who drink are more likely to have a miscarriage or stillbirth. Other risks to the fetus include a higher chance of having birth defects and fetal alcohol spectrum disorder (FASD). FASD is the technical name for the group of fetal disorders that have been associated with drinking alcohol during pregnancy. It causes abnormal facial features, short stature and low body weight, hyperactivity disorder, intellectual disabilities, and vision or hearing problems.

Cigarette smoking

Smoking during pregnancy puts the fetus at risk for preterm birth, certain birth defects, and sudden infant death syndrome (SIDS). Secondhand smoke also puts a woman and her developing fetus at increased risk for health problems.

Drug use.

 Research shows that smoking marijuana and taking drugs during pregnancy can also harm the fetus and affect infant health. One study showed that smoking marijuana and using illegal drugs doubled the risk of stillbirth. Research also shows that smoking marijuana during pregnancy can interfere with normal brain development in the fetus, possibly causing long-term problems. For more information, visit  Dr. Meeta Nakhare , who is the Best Gynaecologist In Pune