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High Risk Pregnancy

A high-risk pregnancy is any pregnancy that shows a possible threat to the mother or fetus. Some pregnancies can become high-risk as they develop, while others are considered high-risk from the beginning.

Conditions such as diabetes, thyroid disease, and blood clotting disorders (known as thrombophilias) are cause for special concern during pregnancy because of the risk they pose to you and your baby. While most women with these types of conditions have uneventful pregnancies and healthy babies, they do require special monitoring and, in some cases, treatment during pregnancy.

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Diabetes During Pregnancy

If you are diabetic and become pregnant, your health and your baby’s health can be at risk. The risk of having problems is greatest when your blood sugar levels are too high. By controlling your blood sugar levels during your pregnancy, you can reduce the risk of:

  • Macrosomia, which occurs when your blood sugar level is high. This allows too much sugar to go to your baby and can cause the baby to grow too large, making delivery difficult.
  • Preeclampsia, or high blood pressure during pregnancy, can pose severe health problems for you and your baby and may require your baby to be delivered early.
  • Polyhydramnios, which occurs when there is too much amniotic fluid in the sac that surrounds the baby. This can result in preterm labor and delivery.
  • Urinary tract infections, which may occur without symptoms. If the infection is not treated, it may spread from the bladder to your kidneys.
  • Respiratory distress syndrome, making it harder for your baby to breathe after birth.
  • Stillbirth delivery, when a baby has died before birth, occurs more often in babies of women whose diabetes was not well controlled during pregnancy.

By carefully monitoring blood sugar during pregnancy, most diabetic women can have healthy babies. Your doctor will closely monitor you through regular screenings to ensure early detection of any problems you or your baby may be having. You can also take the following steps to manage your diabetes during your pregnancy:

  • Eat a balanced diet consisting of several small meals and snacks throughout the day.
  • See your doctor regularly for checkups and tests.
  • Follow a moderate exercise program as prescribed by your doctor.
  • Check your glucose often each day to keep it at a normal level.
  • Take insulin injections or pills as prescribed by your doctor.

By working together, you and your doctor can control your glucose level to help ensure you have a safe pregnancy and a healthy baby.

In most cases, women with diabetes go into labor normally and have a normal vaginal delivery, with special monitoring of the glucose levels and the baby. If there are problems during pregnancy, labor may need to be induced early.

After birth, most babies do well. Some babies may need to spend time in a special care nursery due to problems such as:

  • Low glucose levels
  • Low blood calcium and magnesium levels
  • An excess of red blood cells
  • Neonatal jaundice (yellow discoloration of the skin)
  • Breathing problems

In most cases, these problems are not serious and are treated soon after birth. If your blood sugar levels are well controlled during pregnancy, your baby is less likely to have problems after birth. Women with diabetes can breastfeed their babies in most cases.

Gestational Diabetes

Diabetes is a condition that causes high levels of glucose in your blood. Glucose is a sugar that is your body’s main source of energy. Health problems can occur when your glucose levels are too high. When diabetes starts during pregnancy it is called gestational diabetes and it is of special concern.

Gestational diabetes can occur when no risk factors or symptoms are present; therefore, pregnant women are tested for this condition. Gestational diabetes can potentially harm the health of your baby, so it is important to monitor your glucose levels closely.

Working With Your Doctor

By working together, you and your doctor can control your glucose level to help ensure you have a safe pregnancy and a healthy baby.

If you develop gestational diabetes, you will be monitored closely during your pregnancy. Your doctor will conduct regular tests to detect any problems early so that steps can be taken to correct them. These tests may include:

  • Ultrasound uses sound waves to create pictures of your baby, allowing your doctor to check the baby’s growth and development.
  • Electronic fetal monitoring helps your doctor detect signs of problems your baby may be having late in pregnancy.
  • A biophysical profile uses electronic fetal monitoring and ultrasound results to assess the well-being of your baby.

A kick count is a record of how often you feel your baby move. You may be asked to keep track of this movement in the latter part of pregnancy and to contact your doctor if your baby is not active.

Preeclampsia

Normal blood pressure levels are key to good health. When your blood pressure becomes too high, it is known as hypertension. This condition can pose serious health risks at any time. During pregnancy, hypertension can cause added problems. In some cases, preeclampsia, a serious disorder that can affect your pregnancy and your health, may develop. Preeclampsia occurs when your blood pressure reaches levels of 140/90 or higher after your 20th week of pregnancy, there is extremity swelling and protein spillage in the urine.

Signs of Preeclampsia

Preeclampsia can have serious side effects for you and your baby; therefore, it is important to be aware of its warning signs. If you have any of these symptoms, talk with your doctor right away:

  • Headaches
  • Vision problems
  • Rapid weight gain
  • Swelling of the hands and face

If you develop preeclampsia during your pregnancy, you will need special medical care.

Risk Factors

Doctors do not know why some women get preeclampsia; however, they do know that certain women are at higher risk. The risk of developing preeclampsia is increased in women who:

  • Are pregnant for the first time
  • Have had preeclampsia in a previous pregnancy
  • Have a history of chronic hypertension
  • Are 35 years or older
  • Are carrying more than one fetus
  • Have certain medical conditions, such as diabetes or kidney disease
  • Are obese
  • Are African American
  • Have certain blood diseases or immune disorders, such as lupus

What You Can Do

If you know you have high blood pressure, there are steps you can take before and during your pregnancy to reduce the chance that preeclampsia will harm you or your baby. Before your pregnancy, you can:

  • Work with your doctor to lower your blood pressure.
  • Lose weight through diet and exercise, if needed.
  • Take blood pressure medication as prescribed.
  • Ask your doctor if your blood pressure medication is safe to use during pregnancy.

Working with your doctor to control your blood pressure level will help improve your chances of having a healthy baby.

During your pregnancy, you can:

  • See your doctor regularly.
  • Tell your doctor if you have kidney disease or other risk factors.
  • Let your doctor know right away if you develop any of the warning signs.
  • Check your blood pressure and weight at home, if your doctor recommends it.

Treatment

If your blood pressure increases slightly during your pregnancy, bed rest at home or in the hospital may help keep preeclampsia from developing. If preeclampsia does develop, the only real treatment is to have the baby because continuing the pregnancy can result in damage to your organs, including your kidneys, liver, brain, heart, and eyes. Although preeclampsia typically lasts for up to two weeks after delivery, it always goes away after a pregnancy.

The decision to deliver the baby depends on the risks to you and whether the risk to your baby is greater staying inside your uterus or in a special nursery. Your doctor will explain the best and safest way for the delivery to occur.

Thyroid Disease During Pregnancy

Thyroid disease can pose a risk to you and your baby during pregnancy. However, with close monitoring and proper medical treatment, you can reduce the risks and have a healthy baby.

Throughout your pregnancy, your doctor will regularly check the levels of the thyroid hormone in your body to be sure they are at healthy levels. Though many of the medications used to treat thyroid disease are safe for your unborn child, your doctor will also closely monitor your baby throughout your pregnancy.

If you have a history or symptoms of thyroid disease and are thinking of becoming pregnant or are pregnant already, it is important to talk to your doctor. The chance of problems is greatest when thyroid disease is not monitored, treated, and controlled during pregnancy.

Risks of Hypothyroidism

For Your Baby:

  • Smaller than normal birth weight
  • Preterm birth (born before 37 weeks of pregnancy)
  • Decreased mental ability

For You:

  • Preeclampsia
  • Placental abruption

Risks of Hyperthyroidism

For Your Baby:

  • Smaller than normal birth weight
  • Preterm birth (born before 37 weeks of pregnancy)
  • Possible death
  • Hyperthyroidism

For You:

  • An irregular heartbeat or heart failure
  • Thyroid storm
  • Preeclampsia
  • Placental abruption

Thrombophilias During Pregnancy

Thrombophilias refers to a group of disorders that promote blood clotting. If you have one of these disorders, your body tends to form blood clots easily. As many as one in five people in the United States have thrombophilias, though many do not know because they have no symptoms.

Signs of thrombophilia are more common during pregnancy. Most women with a thrombophilia have healthy pregnancies; however, the condition can contribute to a number of pregnancy complications:

  • Fetal loss/miscarriage
  • Poor fetal growth
  • Placental abruption
  • Preeclampsia
  • Venous thromboembolism, or VTE

 Most of the problems that occur during pregnancy are believed to result from blood clots in placental blood vessels that lead to placental changes and reduced blood flow to the baby.

The risk of blood clots or pregnancy complications due to thrombophilia appears to be less than one percent in women with no history or family history of blood clots. Your doctor may recommend a screening test if:

  • You have had any type of blood clot.
  • You have a family history of blood clots, pulmonary embolism, or strokes that occurred before age 60.
  • You have a history of pregnancy complications (i.e. several miscarriages).

If you test positive for thrombophilia and your doctor believes your risk of blood clots and pregnancy complications is strong enough, you may be treated with a blood-thinning drug called heparin. This drug is given by injection daily and is safe for your baby because it does not cross the placenta. However, most women with a thrombophilia disorder need only to be monitored closely throughout pregnancy.

Ask Your Provider About Care for High-Risk Pregnancy

Even if you have specific factors for a high-risk pregnancy, you can still experience a healthy pregnancy and delivery. Your Capital Women’s Care provider will ensure that you receive the care you need throughout pregnancy and post-delivery. Contact your provider to discuss your pregnancy options today!