High-Risk Pregnancy: What You Need to Know

21 March 2022

Understanding High-Risk Pregnancy: Maternal and Fetal Conditions

High-risk pregnancies typically are divided into two main categories. The first category relates to maternal conditions, and any individual younger than 17 years old or older than 35 years old is considered high-risk. A body mass index of more than 30, and any underlying medical conditions such as diabetes, high-blood pressure, kidney problems, heart problems, autoimmune diseases such as SLE or rheumatoid arthritis, or underlying cancers in the mother are also reasons for concern.

Fetal conditions make up the second category of high-risk pregnancies, such as twin or multiple pregnancies. Evidence of congenital defects or placental disorders also requires extra precautions to ensure a safe pregnancy. 

“It is also important to note any history of previous adverse pregnancy outcomes or pregnancy losses or family history of genetic syndromes come under high-risk pregnancies,” says Dr Janani Sivanathan, Obstetrician and Gynaecologist specialising in Maternal Fetal Medicine at Sunway Medical Centre.

Preparation for a safe pregnancy for both mother and baby

Preparing for a pregnancy is an essential part of the amazing journey to follow; the amount of care and energy required to carry a human being in your womb until birth is not without some risks. Therefore, it is important to understand what your body is up against and remember that your body is unique; just because other people have had either positive or negative experiences doesn’t mean the same applies to you. So be sure to see a qualified obstetrician and gynaecologist who will be able to give you the best advice on how to care for your body during your pregnancy.

Warning Signs to Watch for During a High-Risk Pregnancy

It is quite normal to have bouts of morning sickness when you’re pregnant, but if you’re suffering through very severe nausea and vomiting (hyperemesis) whereby you’re unable to take in any food or drink orally in the early stages of pregnancy, get yourself admitted.

If you are experiencing bleeding in the second trimester, this may be a sign of having a second-trimester miscarriage and losing the pregnancy before it’s viable.

Next, and perhaps the most important, is the risk of developing preeclampsia, where symptoms brought about by very high blood pressure such as headaches, blurring of vision, or gastric-like symptoms such as epigastric pain or vomiting, swelling of the legs and facial puffiness, and fits can cause bleeding in the brain and in severe cases, death to the mother and the baby.

“For the mother, the risk of developing preeclampsia–a pregnancy complication characterised by high blood pressure and signs of damage to other organs, most often the liver and kidneys, means that they need to be on adequate supplements,” says Dr Janani. It is also important to note that having certain conditions before you become pregnant — such as type 1 or type 2 diabetes, kidney disorders, a tendency to develop blood clots, or lupus — also increases your risk of preeclampsia.

Finally, as pregnancy is a hypercoagulable state wherein the blood is much thicker, there is a risk of blood clot formation in the legs if a woman is on the obese side or immobile. The blood clot can go up to the lungs, causing pulmonary embolism which may lead to maternal death.

Managing a High-Risk Pregnancy: Expert Advice from Dr. Janani Sivanathan

Women with high-risk pregnancies should see a maternal-fetal medicine specialist for at least one or two visits, and go for prenatal screening for genetic syndromes in the baby during their first trimester.

“A special scan is done in the first trimester, which is called the nuchal scan or nuchal thickness scan to see if the baby is at risk of developing any genetic syndromes,” adds Dr Janani. “The next visit would be for the detailed anomaly scan between 20-24 weeks.”

Just because you fall into the high-risk pregnancy category doesn't mean you can’t get pregnant at all. In fact, many high-risk pregnancies end up successful; you simply need to know what you’re up against.

“This is why it’s important to attend the preconception clinic or assessment to ensure that the underlying illnesses are all in remission or stable and that it is safe for you to get pregnant,” says Dr Janani, adding that it is key to get advice and clearance from a doctor before safely embarking on a pregnancy.


Approaches That Can Help You Prepare for Pregnancy:

To begin with, your doctor will check to see that you are physically, emotionally, and mentally fit to start on your journey through motherhood.

There are many approaches that can help you get started on the right path:

  1. Have a healthy lifestyle
  2. Take the necessary supplements and consume folic acid pre-pregnancy
  3. Stop smoking and drinking alcohol
  4. Avoid exposure to external chemical agents
  5. Avoid certain drugs or medication that may not be suitable in the pregnancy; a safer type of medication can be used instead upon doctor’s advice.

Once pregnant, be sure to have an early checkup to ensure that the pregnancy is actually in the womb and not outside the womb (ectopic pregnancy). Follow up with regular antenatal care and do the necessary tests advised, such as a pregnancy booking test, genetic test, blood sugar, and preeclampsia tests.

Does Covid-19 make my pregnancy high-risk?

Covid-19 and its many variants have now become endemic, and it is now with us in the community. We need to learn to live with it, but it is especially important to ensure that we are vaccinated.

“Women who are pregnant but not vaccinated are definitely at a very high risk of developing morbidity and mortality should they get infected with COVID-19,” says Dr Janani. “Hence, if you want to get pregnant, please get yourself vaccinated first and ensure that family members do too because the exposure can be from various sources.”

She stresses that following through with the SOPs such as wearing your mask, hand hygiene, and avoiding crowded places as much as possible is crucial during pregnancy. “Being pregnant is a slightly immunocompromised state, and women can be severely affected if they do get COVID-19.”