High-Risk Pregnancy: Introduction and Risk Factors

There is no formal or universally believed explanation of a high-risk pregnancy. However, a high-risk pregnancy generally involves at least one of the following:

That the probability that the woman or the baby will die or become ill is higher than usual.

That the probability of complications appearing before or after delivery is higher than usual.

Many women with complex, high-risk pregnancy conditions benefit from treatment in a specialized center attended by doctors who specialize in high-risk pregnancies.

In the United States, in 2017, 19 women died for every 100,000 deliveries. In the United States, nearly half of pregnancy-related deaths occur in African-American women. The maternal mortality rate is higher in the United States than in other Western countries, such as the following:

Globally, the maternal mortality rate varies greatly by race and ethnicity. In the United States, the maternal mortality rate is 3 times higher for women of African descent and 2.5 times higher for women of American Indian and Alaska Native descent than it is for women of Caucasian descent. On other hand Brazil, maternal mortality is approximately 5 times higher among women of African descent than among those of Caucasian descent. In the UK it is much higher among women of African descent than among those of Caucasian descent.

• Bleeding (hemorrhage), which accounts for more than a quarter of deaths
• High blood pressure, including preeclampsia (a kind of high blood pressure that emerges during pregnancy)
• Sepsis (severe generalized [systemic] body response to infection)
• Miscarriage
• Complications of childbirth (Read Also: 6 Types of childbirth and their characteristics)
• Pulmonary embolism
• Conditions that the woman suffered before becoming pregnant (such as obesity and infectious diseases, including HIV infection)

About 3 in 5 maternal deaths could be prevented.

Perinatal mortality refers to the death of fetuses and newborns occurring close to the time of delivery.

In the United States, the perinatal mortality rate is 6 to 7 deaths per 1,000 deliveries.

The most common causes of death in fetuses and newborns are:

• Complications of childbirth
• Infections
• Placenta abnormalities, such as premature detachment of the placenta ( abruptio placentae, abruption placenta, or ablatio placentae ) or a placenta previa ( placenta that is misplaced or displaced )
• Genetic abnormalities in the fetus
• Congenital abnormalities

A high-risk pregnancy is made up of certain circumstances or characteristics called risk factors. As part of routine pregnancy care, doctors identify these factors to determine the degree of risk for each woman and baby to provide better medical care. Genetic evaluation is particularly important. It consists of evaluating the couple’s family history and, if necessary, testing blood or tissue samples (such as cells from the inside of the cheek). This evaluation is done to determine if a couple is at increased risk of having a baby with an inherited genetic disorder.

Factors that can affect risk in women include:

A high-risk pregnancy requires close monitoring, and women are sometimes referred to a center specializing in the care of these types of pregnancies.

The most common reasons for this referral before delivery are:

• Preterm (premature) delivery (often due to premature rupture of the membranes )
• Preeclampsia
• Disorders that were already present before or developed during pregnancy, such as diabetes, high blood pressure, and severe (morbid) obesity.

Risk factors for high-risk pregnancy

Some risk factors are present before women become pregnant. These risk factors are:

• Certain physical characteristics such as the age and social characteristics of women
• Problems in a previous pregnancy
• Certain disorders present before pregnancy
• Exposures that can harm the fetus

Other problems that increase risk can develop during pregnancy and delivery.

The need for surgery during pregnancy (particularly abdominal surgery) increases the risk of premature delivery and miscarriage, especially early in pregnancy. For this reason, the intervention is postponed as long as possible. However, if accurate, surgery should be done without delay and is generally reasonably safe.

The following characteristics of women affect risk during pregnancy.

About 13% of all pregnancies occur in teenagers. These girls are at increased risk of high-risk pregnancy

Women 35 years of age and older are at increased risk of having the following:

As women age, genetic testing for chromosomal abnormalities becomes more important.

Read Also: The First month of pregnancy: |Pregnancy stages|

Women who are very thin, with a body mass index less than 19.8 (see the Determination of Body Mass Index table ), or who weigh less than 100 pounds (45 kg) before becoming pregnant are more likely to

Women are shorter than 1.50 m are more likely to have a small pelvis, which can make it difficult for the fetus to pass through the pelvis and vagina (birth canal) during delivery. For example, the fetus’s shoulder is more likely to fit against the pubic bone. This complication is called shoulder dystocia. Women of short stature are also more likely to have a premature ( preterm ) delivery and a low birth weight baby (small for gestational age).

Structural abnormalities of the uterus or cervix increase the risk of the following:

• A difficult delivery
• A miscarriage during the second trimester and preterm labor
• A fetus in an abnormal position
• Preterm labor or a premature baby
• Need for cesarean delivery

Structural abnormalities consist of a double uterus, fibroids in the uterus, and a weak (incompetent) cervix ( cervical insufficiency ) that tends to dilate as the fetus increases in size. Fibroids sometimes cause misplacement of the placenta (called placenta previa ), too early a start of labor ( preterm labor ), and miscarriages. Cervical insufficiency increases the risk of a baby being born too early (preterm labor).

Being single or belonging to a low socioeconomic group increases the risk of problems during pregnancy. The reason these characteristics increase the risk is not very clear, but it is probably related to other factors that are more frequent among these women. For example, these women may be more likely to smoke, less likely to eat a healthy diet, more likely to have unprotected sex, and less likely to get proper medical care.

When women have had a problem in one pregnancy, they are more likely to have another problem, often the same, in subsequent pregnancies. These problems include having any of the following:

These women may have a condition that causes the same problem to recur. For example, women with diabetes are more likely to have babies weighing more than 5 kg at birth.

Women who have had a newborn with a genetic disorder or birth defects are more likely to have another baby with a similar problem. Before trying to get pregnant again, it may be appropriate to perform genetic tests on the baby (even stillborn) and the parents. If these women become pregnant again, certain tests, such as high-resolution ultrasound, chorionic villus biopsy, and amniocentesis, may be done to determine if the fetus has a genetic disorder or birth defect. These women can be referred to a specialist.

Being pregnant 5 or more times increases the risk of having premature contractions and excessive bleeding after delivery.

• Underweight babies
• Preterm (premature) delivery
• Placenta separating too soon ( placental abruption )
• Congenital abnormalities
• Stillbirth or death of the newborn

Before becoming pregnant, a woman may have a disorder that increases the risk of pregnancy problems. These disorders include

Women with one of these disorders should speak with a doctor to try to be in the best possible physical condition before becoming pregnant. Once they are, they may require special care, often from an interdisciplinary team. The team may consist of an obstetrician (who may also be a specialist in the disorder), a specialist in the disorder, and other health professionals (such as nutritionists).

During pregnancy, a problem may arise or a disorder may occur that makes it a high-risk process.

Certain disorders that occur during pregnancy are related to or are complications of pregnancy. Other disorders are not directly related to pregnancy. Certain disorders are more likely to occur because of all the changes pregnancy causes in a woman’s body.

Complications of pregnancy are problems that appear during pregnancy. They can affect the woman, the fetus, or both and occur at different times during pregnancy. For example, complications such as a displaced placenta ( placenta previa ) or your premature detachment of the uterus ( placental abruption ) can cause bleeding into the vagina during pregnancy. Women who bleed heavily are at risk of losing the baby or going into shock and, if not treated right away, dying in childbirth.

• Problems related to amniotic fluid (the fluid that surrounds the fetus in the womb)
• A weak cervix ( cervical insufficiency ) that tends to open (dilate) as the fetus grows
• An infection of the tissues around the fetus, such as amniotic fluid ( intra-amniotic infection )
• Spontaneous abortion or stillbirth previous
• Preeclampsia (a type of high blood pressure that occurs during pregnancy)
• Rh incompatibility (when the mother has Rh-negative blood and the fetus has Rh-positive blood)

During pregnancy, the risk of having a baby with a birth defect can be increased by exposure to the following:

These types of substances and conditions are called teratogens.

The birth defects are more likely to occur if women are exposed to a teratogen 2 to 8 weeks after becoming pregnant (4 to 10 weeks after their last menstrual period) since the body’s fetus is formed during this period. The risk of miscarriage also increases.

Infections that are particularly dangerous during pregnancy include:

Some prescription drugs (see table Medications That May Cause Problems During Pregnancy )

Exposure to high temperatures (for example, in a sauna) during the first trimester has been linked to spina bifida.

Consuming too much mercury in fish and shellfish can harm the fetus. However, fish and shellfish contain nutrients that are important for the growth and development of the fetus and breastfed babies. Therefore, the Food and Drug Administration (FDA) recommends that women who are pregnant, could become pregnant, or are breastfeeding:

• Do not eat tilefish from the Gulf of Mexico, shark, swordfish, bigeye, marlin, and king mackerel.
• Limit the amount of albacore tuna to 4 ounces (about 113 grams, an average meal) a week.
• Before consuming fish that come from lakes, rivers, and coastal areas, check the advisories of the local councils on the safety of this type of fish, and if it is not known with certainty if the mercury levels are low or not This information is available, limit the amount consumed to 4 ounces (about 113 grams, an average meal) per week and do not consume other fish or shellfish that are high in mercury during that week.
• Each week, consume 8 to 12 ounces (between 240 and 360 grams, 2 or 3 medium meals) of a variety of fish and shellfish that are lower in mercury.

Originally published at https://kidsrush.com on March 9, 2021.