high risk pregnancy twins

High Risk Pregnancy

What is High Risk Pregnancy?

A high-risk pregnancy is one in which there is a higher likelihood of complications arising during pregnancy, childbirth, or the postpartum period. While there is no universally accepted definition of a high-risk pregnancy, it generally encompasses situations where the woman or baby has a higher risk of illness or adverse outcomes, either before or after delivery. It’s important to note that high-risk pregnancies can still result in positive outcomes, they do necessitate increased medical monitoring compared to low-risk pregnancies. Women who anticipate being in a high-risk pregnancy situation should consult with their obstetricians before conceiving and exercise caution when considering assisted reproductive technologies like in-vitro fertilization.

Did You Know…
Roughly one out of every ten pregnancies fall into the high-risk category. However, the classification of “high risk” or “low risk” serves as a tool for obstetricians to assess the potential for complications. Many high-risk pregnancies conclude with healthy outcomes, and occasionally, unexpected complications arise in low-risk pregnancies. Not all issues are foreseeable, but low-risk and high-risk expectant mothers can still achieve safe deliveries and healthy babies.

What Puts You at Risk?

Several factors can lead to the classification of a pregnancy as “high risk.” These include:

1. Pre-existing Risk Factors

Certain physical attributes like age and weight can impact pregnancy. These include:

  • Age: Adolescents (13% of pregnancies) face an increased risk of complications such as preeclampsia, preterm labor, anemia, and small-for-gestational-age babies due to reduced medical care utilization and risky behaviors.
  • Age Over 35: Older women are at risk of preexisting disorders (e.g., high blood pressure, diabetes), pregnancy-related issues (e.g., preeclampsia, gestational diabetes), complications during labor, and fetal chromosomal abnormalities.
  • Weight: Body mass index (BMI) affects pregnancy risks:
    • Underweight: BMI below 19.8 increases the likelihood of having underweight babies.
    • Overweight and Obesity: BMI of 25 to 29.9 (overweight) and BMI over 30 (obesity) are associated with risks such as large-for-gestational-age babies, birth defects, miscarriages, gestational diabetes, and preeclampsia. Exercise and dietary changes are encouraged for overweight and obese women.
  • Height: Women shorter than 5 feet are more likely to encounter difficulties during labor, such as shoulder dystocia, preterm labor, and small-for-gestational-age babies.

2. Expecting multiple babies

having twin triplet or higher order pregnancy carries a higher risk of complications like preterm delivery, need for cesarean section or post-partum hemorrhage

3. Past Pregnancy Complications

Following previous pregnancy issues may reoccur:

  • Premature Birth
  • Underweight Baby
  • Large-for-Gestational-Age Baby
  • Birth Defects
  • Miscarriage
  • Multiple Pregnancy Losses
  • Late Delivery (post term pregnancy)
  • Rh Incompatibility Requiring Fetal Blood Transfusion
  • Cesarean Delivery
  • Stillbirth

4. Genetic Disorders

Certain genetic disorders within either partner, their respective families, or a previous child can significantly increase the risk of a high-risk pregnancy. These genetic conditions may include inheritable diseases, chromosomal abnormalities, or other genetic factors that can impact the health of both the mother and the developing baby.

5. Lifestyle choices or Exposure to Harmful Substances

Exposure to certain substances and conditions during pregnancy can elevate the risk of birth defects:

  • Infections: Including chickenpox, hepatitis, herpes simplex, rubella, syphilis, toxoplasmosis, and various viruses.
  • Drugs: Such as alcohol, tobacco, cocaine, and specific prescription medications.
  • Radiation and Chemical Exposure: Carbon monoxide, lead, gasoline, and mercury can be teratogenic.
  • High Temperatures: Sauna exposure in the first trimester may contribute to spina bifida.

6. Pre-existing Health Conditions

Certain health conditions increase the risk of problems during pregnancy:

  • High Blood Pressure
  • Diabetes
  • Kidney Disorders and Infections
  • Heart Failure
  • Sickle Cell Disease
  • Sexually Transmitted Infections
  • Fallopian Tube Problems

7. Pregnancy Related Complications:

Issues such as mislocated placenta (placenta previa) or premature placental detachment (placental abruption) can lead to bleeding. Amniotic Fluid problems like increased or reduced amount of amniotic fluid can be harmful for the baby. Cervical Insufficiency or a weak cervix that tends to dilate as the fetus grows causes premature rupture of membranes and preterm delivery. Severe Nausea and Vomiting in pregnancy can cause maternal exhaustion, weakness and dehydration. Certain Infections around the fetus, such as intra-amniotic infection can harm the baby and cause sepsis in mother. Preeclampsia or eclampsia, a type of high blood pressure during pregnancy, is especially dangerous for the life of mother and fetus. Rh Incompatibility occurs when the mother is Rh-negative and the fetus is Rh-positive with development of antibodies in the mother that damage the fetus.

8. Reproductive Abnormalities

Structural abnormalities in the uterus or cervix can lead to complications like:- difficult labor, miscarriage (2nd trimester), preterm labor, fetus in abnormal position and need for cesarean deliver. Structural issues include double uterus, uterine fibroids, and a weak cervix (cervical insufficiency).

Pregnancy Risk Assessment

Pregnancy risk assessment involves evaluating factors that may increase the likelihood of complications for both the mother and baby during pregnancy. Based on this evaluation the pregnant lady is placed in a high or low risk category. While there is no universally accepted definition of a high-risk pregnancy, it generally encompasses situations where the woman or baby has a higher risk of illness or adverse outcomes, either before or after delivery.

What to Expect in a High-Risk Pregnancy

If your pregnancy is classified as high risk, anticipate more frequent prenatal appointments compared to those with low-risk pregnancies. Additionally, you may undergo extra screenings, such as amniocentesis, chorionic villus sampling (placental cell analysis), and cervical length measurements. These screenings serve to assess your risk for potential issues like pre-term labor or the possibility of your child having specific genetic conditions.

Special Prenatal Care Instructions

Your prenatal care will differ from that of low-risk pregnancies, and your obstetrician may provide unique care recommendations, such as advising against exercise or recommending bed rest during your pregnancy. You may be advised against travelling or exertion if you have a low placenta that keeps on bleeding frequently or carry twin pregnancy and if there is a danger of preterm birth. It’s essential to address any concerns about your high-risk pregnancy care before conception or during your initial prenatal visit.

  • Genetic Evaluation: For some couples, genetic evaluation is recommended to assess the risk of hereditary genetic disorders. This evaluation typically involves an analysis of the couple’s family history and, if necessary, the examination of blood or tissue samples.
  • Specialized Care for High-Risk Pregnancies: Women with high-risk pregnancies often benefit from specialized care provided by doctors who specialize in managing such pregnancies. She may be referred to a diabetologist or endocrinologist if she has pre existing or pregnancy related disorders like diabetes or other hormonal problems. Similarly she may be referred to a heart or lung specialist in case of pre existing  or new heart or lung condition. Close monitoring and additional medical attention may be required to ensure the well-being of both the mother and baby.
  • Ensuring Your Baby’s Well-Being: If you are navigating a high-risk pregnancy, you may naturally worry about your baby’s safety. This concern is entirely normal. However, with proper prenatal care, it is feasible to have a healthy baby. Healthy mothers tend to give birth to healthy babies, underscoring the importance of discussing your healthcare provider’s recommendations to ensure the safety and well-being of both you and your baby.

How can I reduce the risk of pregnancy complications?

To mitigate the risk of pregnancy complications in high-risk situations, consider the following steps:

  1. Preconception Planning: If you’re not yet pregnant, arrange a preconception visit with your healthcare provider. Ideally, schedule this several months in advance (or longer, depending on your specific condition) before attempting to conceive. This lead time allows you to implement any recommended changes to your health before becoming pregnant.
  2. Educate Yourself: Seek comprehensive information about your condition and the measures you can take to maintain your health. Don’t hesitate to request information from your healthcare provider.
  3. Prenatal Visit Disclosure: During your initial prenatal visit, inform your healthcare provider about any existing health issues, current medications, and any challenges you encountered in prior pregnancies.
  4. Regular Prenatal Appointments: Attend all scheduled prenatal appointments and adhere to your doctor’s guidance.
  5. Healthy Lifestyle: Embrace a healthy lifestyle by following your provider’s dietary recommendations, achieving appropriate weight gain, and engaging in physical activity if feasible.
  6. Avoid Harmful Substances: Refrain from smoking and alcohol consumption.
  7. Emotional Well-Being: Prioritize your emotional well-being. Allocate time for self-care and endeavor to reduce stress levels whenever possible.
  8. Seek Support: Don’t hesitate to seek support from your partner, family, and friends. High-risk pregnancies can be emotionally taxing, and their assistance can be invaluable during this challenging period.

How can I Ensure a Healthy Outcome for High-Risk Pregnancy?

The concern for your baby’s well-being during a high-risk pregnancy is completely natural. Fortunately, with proper prenatal care, it is possible to achieve a positive outcome and deliver a healthy baby, even in high-risk situations. Effective communication with your healthcare provider is paramount, enabling you to address concerns and take necessary steps to ensure both your and your baby’s health. Here are some essential guidelines to follow:

Open Communication with Your Doctor

  • Maintain an open line of communication with your healthcare provider.
  • Discuss your concerns about your high-risk pregnancy openly.
  • Inform your doctor about any medications you are taking.
  • Allow your doctor to adjust your medications if they pose risks to your baby.

Note: Always consult your healthcare provider before discontinuing any medication.

Potential Complications and Neonatal Intensive Care

Complications arising from drug interactions or health issues can lead to premature childbirth. Premature birth can result in various challenges, including difficulty in breathing and feeding, along with other potential complications. In such cases, your baby may require extended hospitalization for stabilization and recovery, as well as specialized care in the Neonatal Intensive Care Unit (NICU).

By proactively addressing these factors and maintaining a strong partnership with your healthcare provider, you can increase the likelihood of a positive outcome for both you and your baby, even in the face of a high-risk pregnancy.


Dr Sobia Mohyuddin

MCPS, FCPS, MRCOG, Consultant Obstetrics & Gynaecology

Doctor Sobia Mohyuddin is a highly skilled and experienced Obstetrician and Gynecologist, with 25 years of training and experience in renowned, large institutions. She holds the position of Associate Professor and Fellow at the College of Physicians and Surgeons Pakistan. She is also a member of the Royal College of Obstetricians and Gynecologists (UK).