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What is a High Risk Pregnancy?
Learn what to expect during a high-risk pregnancy and explore steps you can take to stay healthy and support your baby’s development.
A high risk pregnancy is one where the mother, the baby, or both have a higher chance of experiencing health complications before, during, or after delivery compared to a typical pregnancy.
This doesn't necessarily mean a complication will occur, but it does mean your healthcare team may recommend extra monitoring, specialist care, and more frequent check ups to help manage risks and support a healthy outcome for you and your baby.
What Makes a Pregnancy High Risk?
Several factors can contribute to a pregnancy being classified as high risk. Your midwife or doctor will work closely with you to identify and manage these risks.
Health conditions before pregnancy
Pre-existing chronic health issues can increase the chance of complications for both mother and baby. The following list of high risk pregnancy conditions require close management:
Firstly, is diabetes (Type 1 or 2), aspoorly controlled blood sugar levels can impact your baby's development and increase the risk of preeclampsia, which is a serious condition involving high blood pressure, often with signs of damage to another organ system, such as the liver or kidneys.
Secondly, hypertension (high blood pressure)raises the risk of complications like preeclampsia and fetal growth restriction.
Some autoimmune conditionslike Lupus or Rheumatoid Arthritis require close monitoring. Both can increase risk of low birth weight, and pregnancy may also cause flare ups of some autoimmune conditions.
Finally, heart or kidney conditions can place extra strain on the mother's body when pregnant, which is having to work harder than usual to manage the increased blood volume that pregnancy demands.
Issues that arise during pregnancy
Sometimes, a risk factor develops as the pregnancy progresses, and these require prompt intervention:
Gestational Diabetes
One condition is Gestational Diabetes (GD), which occurs when high blood sugar levels develop during pregnancy. This happens because hormonal changes can make it harder for the body to use insulin effectively, leading to raised glucose levels. If not managed properly through diet, lifestyle changes, and sometimes medication, GD can increase the risk of complications such as having a larger baby, premature delivery, and the need for a caesarean section. It can also raise the mother’s risk of developing type 2 diabetes later in life.
Preeclampsia and Eclampsia
Preeclampsia (and Eclampsia)is a serious condition in pregnancy involving high blood pressure, often with signs of damage to another organ system, such as the liver or kidneys. If preeclampsia progresses without treatment, it can lead to Eclampsia, which involves seizures and can be life-threatening for both mother and baby. Early detection through regular blood pressure monitoring and urine testing is crucial. The condition can be treated with medication, and in some cases, a planned caesarean or induction.
Placenta previa
Placenta Previa is a condition where the placenta partially or totally covers the mother's cervix, potentially causing severe bleeding. Women diagnosed with placenta previa are closely monitored with ultrasound scans, advised to avoid strenuous activity, and may require a planned caesarean section to ensure a safe birth.
Fetal growth issues
Finally, are fetal growth issues which are when the baby is growing slower or faster than expected, and can be linked to other health conditions. Regular ultrasounds and fetal monitoring help track development and guide decisions about delivery to ensure the best possible outcomes.
All of these pregnancy-related risk factors can be managed effectively with close monitoring, and it is especially important to attend all maternity and medical appointments.
Age and lifestyle factors
Your age and lifestyle choices can contribute to risk, and making changes to modifiable risk factors (things that you can change like diet or smoking), are strongly encouraged during your pregnancy.
High risk pregnancy age includes being under 20 or over 35. Pregnancy at these ages slightly increases the risk of complications like preterm birth and chromosomal abnormalities. While being over 35 is often termed 'advanced maternal age,' many women have healthy pregnancies in their late 30s and 40s.
Lifestyle related factors include smoking, alcohol use, or illegal substance use. Research indicates that these are significant risk factors and should be avoided throughout pregnancy. Being honest with your midwife or doctor about substance use is recommended so that a plan can be made for safely monitoring your baby’s health.
Finally, poor nutrition including a lack of essential nutrients, especially Folic Acid, can be a concern. Focusing on a balanced diet is encouraged and our blog about eating during pregnancy provides further information about the best ways to achieve this.
Multiple pregnancies or IVF
Carrying more than one baby automatically increases the workload on your body and often requires extra monitoring. Multiple pregnancies of twins, triplets and more, have higher rates of preterm birth, preeclampsia, and low birth weight.
Pregnancies conceived via IVF or Assisted Reproductive Technology (ART) may have increased monitoring due to a slightly higher risk of complications.
Previous pregnancy complications
Your past obstetric history is one of the most important predictors for future pregnancies:
A history of delivery before 37 weeks (past preterm birth) can significantly raise the likelihood of it happening again. Also, previous miscarriage or stillbirth may need a more in depth investigation and additional care in the current pregnancy. Finally, a history of previous preeclampsia or placental issues often need preventative medication and closer monitoring in subsequent pregnancies.
What care is needed for high risk pregnancies?
Regular antenatal appointments
Expect to have more frequent check ups than those with low risk pregnancies. These appointments might be with your midwife, obstetrician, or a combination of specialists. More frequent monitoring allows your care team to spot subtle changes in your health or your baby's development.
Seeing a maternal fetal medicine specialist
A Maternal-Fetal Medicine (MFM) specialistis an obstetrician with advanced training in managing complex, high risk pregnancies. They can offer specialised care such as genetic testing, fetal surgery and advanced diagnostic ultrasounds.
Tests and screenings you may be offered
Advanced ultrasounds
These ultrasounds go beyond the standard growth scans to assess specific aspects of the pregnancy:
- Biophysical Profile (BPP): Assesses fetal movement, fetal heart rate, breathing, muscle tone, and amniotic fluid volume.
- Doppler Flow Studies: Measures blood flow in the umbilical cord and other fetal vessels, crucial for babies with growth concerns.
- Cervical Length Check: Used for women at risk of preterm birth - a shorter cervix length can indicate a higher risk
Genetic tests and screening
These are offered to assess the baby's chromosomal health and risk of genetic conditions:
- Cell-Free DNA (cfDNA) Screening: A non invasive blood test usually taken after 10 weeks of pregnancy that screens for conditions like Down's Syndrome, Edwards Syndrome and Patau Syndrome.
- Amniocentesis and Chorionic Villus Sampling (CVS): Diagnostic tests that take samples of amniotic fluid and placental cells to provide a definitive diagnosis of certain genetic conditions.
Routine lab tests
Frequent blood and urine tests are essential to:
- Monitor chronic conditions: Ensuring your diabetes or blood pressure remains well controlled.
- Screen for complications: Checking for signs of anaemia, infections, or preeclampsia.
What you can do for a healthy pregnancy
Plan before pregnancy
The ideal time to address risk factors is before conception. If you have a chronic condition, like diabetes or hypertension, consult your healthcare provider for a preconception counselling session. This is an important opportunity to discuss existing conditions, medication options and to consider lifestyle changes before conceiving.
Adopt healthy lifestyle habits
Small, consistent changes can make a big difference during pregnancy and beyond. It is strongly advised to quit smoking and avoid alcohol. This is vital for reducing serious risks to you and your baby. Speak to your midwife or GP about help with quitting smoking.
Moderate exercise in pregnancy is beneficial, unless advised otherwise. Read our blog post about staying active during pregnancy for more information about ways to do this.
Managing stress can be helped with relaxing activities like prenatal massages, which can help you cope. Our blog post has more information about prenatal massages . Finally, is the importance of focusing on a balanced diet and taking your prescribed prenatal vitamins. This is another way to prioritise the health of both you and your baby.
Stay informed and ask questions
Empower yourself by communicating openly with your healthcare team. Don't hesitate to seek reassurance and clarity. You can do this by asking for things to be explained again, explained in a different way, or by asking follow up questions. We have a blog post that explains what questions you might want to ask your midwife.
Warning signs to report right away
Promptly reporting urgent symptoms is very important, especially in a high risk pregnancy. Seek help immediately if you experience any of the following:
- Vaginal Bleeding
- Severe Swelling (especially of the face or hands)
- Reduced Fetal Movement
- Severe or Persistent Headache
- Chest Pain
- Persistent Abdominal Pain
Our blog about the first trimester has more information about what to expect and when to seek help.
How to manage stress during pregnancy
A high risk diagnosis can cause emotional strain and anxiety, during a time that is already filled with emotions and change. Acknowledge these feelings of uncertainty, and find ways to prioritise your mental health and wellbeing. One example is to engage with others through support groups. It can be reassuring to connect with others who understand the unique pressures of a high risk pregnancy.
Also, consider speaking to your care provider about accessing counselling or therapy through local mental health Services. Some people find the process of journaling as a helpful therapeutic tool to process your worries and track your emotional well-being.
FAQs about high risk pregnancy
Pregnancy is considered high risk when there’s an increased chance of complications due to health conditions, pregnancy history, or other risk factors. It is a protective label that simply means you need extra monitoring.
Common reasons include chronic illnesses (like diabetes), advanced maternal age (over 35), carrying multiple babies, or complications in past pregnancies (like a history of preterm birth).
"High-risk" isn't a single category, it can include various conditions or concerns that require closer medical monitoring. Your care will be tailored to your specific underlying risk factor.
Many people with high risk pregnancies can continue working, depending on the specific condition and doctor’s advice. It's important to discuss the nature of your job with your care team; you may need to adapt duties, reduce hours, or take extra precautions.
