Do you have a high-risk pregnancy? Know the signs

Diabetes, high blood pressure, multiples, being older… If you tick these boxes, your pregnancy is more complex than others.

If you’ve been told your pregnancy is high risk, try not to freak out just yet. What it means is that your pregnancy needs extra monitoring and care as a precaution – it’s not a sign that something will definitely go wrong. There are many reasons a pregnancy might be designated as high risk. While the list of possible health criteria for a high-risk pregnancy is a very long one, there are certain factors that automatically put you on the watch list for closer monitoring.

WHAT ARE THE RISK FACTORS?

If you suffer from a medical condition such as diabetes, hypertension (high blood pressure), thyroid disease or kidney disease, your pregnancy will automatically be categorised as high risk. If you’ve had several previous caesarean sections, or you’ve had previous abdominal surgery, this also places you in the high-risk category. Likewise, if your previous obstetric history includes repeated miscarriages, preterm labour or growth restriction of the foetus, this pregnancy will be considered high risk. Needless to say, taking drugs constitutes a high risk to any pregnancy. It’s easy to assume that this only refers to recreational drugtaking, but actually, medication taken to treat a chronic condition may pose a threat to the pregnancy too. “For example, pregnancy in an epileptic patient in itself is considered a highrisk pregnancy. Some of the drugs used for therapy can also cause abnormalities in the development of the baby,” explains Dr Jana Rossouw, a specialist in gynaecology and obstetrics at Tygerberg Hospital in Cape Town.

LIFESTYLE DISEASES

“If you suffer from a lifestyle disease like diabetes, high blood pressure or kidney disease, careful monitoring of the pregnancy is imperative. It includes checking the stability of the disease and picking up any deterioration of current diseases,” says Dr Rossouw. If you suffer from chronic hypertension, you’re at much greater risk of developing pre-eclampsia. High blood pressure can also cause less blood to flow to the placenta, delivering less oxygen and fewer nutrients to your baby. It increases your risk of other complications like intrauterine growth restriction, preterm birth, placental abruption (a rare but serious condition where the placenta rapidly tears away from the inner uterine wall) and even stillbirth. If your chronic hypertension is mild, your risk of these complications is still raised compared to a patient without any pre-existing conditions. Proper blood sugar management is extremely important for diabetic patients. Poorly controlled diabetes immediately puts you at higher risk for developing other foetal complications, such as a very large birth weight baby (which can cause birth complications), premature birth, diabetic kidney disease, pre-eclampsia, and diabetic retinopathy (when high glucose levels damage the retina). “If you suffer from chronic hypertension, indicated deliveries are also planned at term (40 weeks) and for patients suffering from diabetes mellitus, at 37 to 40 weeks,” says Dr Rossouw. Another pregnancy-affecting disease prevalent in South Africa is HIV. For these pregnant mothers, the biggest risk is passing HIV on to their baby. Treatment with antiretrovirals (ARVs) is recommended to minimise the chances of passing HIV to your unborn child. Even if you aren’t taking ARVs when you fall pregnant, it’s recommended to start treatment immediately for the best possible outcome, especially as certain ARVs are safe for use in pregnancy.

STAYING PREGNANT

If you’ve had several miscarriages prior to this pregnancy, you’ll be closely monitored. “Three or more miscarriages before 14 weeks’ gestation may be linked to a genetic abnormality or a uterine abnormality,” says Dr Rossouw. “These patients need specialised care and consultation.” If you’ve had three or more consecutive second trimester miscarriages (from 14 to 26 weeks), this may be indicative of cervical insufficiency. “Specialised care with ultrasound monitoring, progesterone and cervical suturing may be needed,” she cautions.

TIME IS (NOT) ON MY SIDE

Whether you’re older than 35 or younger than 18, age in itself makes the pregnancy high risk from the start. “Teenage pregnancy is a high-risk pregnancy, because it usually is an unplanned pregnancy and patients are prone to seek antenatal care late in the pregnancy. This

complicates monitoring,” says Dr Rossouw. Older pregnant moms run a higher risk of pregnancy complications like pre-eclampsia, gestational diabetes, placenta praevia and premature birth, while the risk of genetic or chromosomal abnormalities climbs.

BABIES ON BOARD

It’s no surprise that when you’ve got more than one baby on board, your pregnancy is regarded as high risk. “Complications may occur like preterm labour, gestational diabetes, hypertension, and growth restriction [of the babies],” comments Dr Rossouw. “Careful monitoring and management of these factors may improve the outcomes for both mom and babies,” she explains. “Multiple pregnancies should be co- managed by a foetal maternal medicine sub-specialist.”

HISTORY USUALLY REPEATS ITSELF

Unfortunately, if you’ve already had a high-risk pregnancy, for example suffering from a pregnancy complication like preeclampsia, gestational diabetes, preterm labour or a stillbirth delivery, you are automatically considered to be a likely candidate for another high-risk pregnancy. “Most obstetric complications from the past history have a higher chance of recurring in the current pregnancy. Therefore, good follow up is needed,” advises Dr Rossouw.

IT MIGHT DEVELOP LATER

Although you may have started out with an

MEDICATION TAKEN TO TREAT A CHRONIC CONDITION MAY POSE A THREAT TO THE PREGNANCY

uncomplicated pregnancy, if you develop a complication of pregnancy such as gestational diabetes or pre-eclampsia later in the pregnancy, it becomes high risk and so will need extra monitoring. Other risks include foetal factors like growth restricted babies (babies who are small for their gestational age), abnormally large babies, genetic conditions, and abnormalities detected during an ultrasound scan (like genetic abnormalities such as Down syndrome).

A CANCER DIAGNOSIS

If you’re unfortunate enough to be diagnosed with cancer during your pregnancy, things get extra risky. The spread of the cancer will need to be closely monitored. “Some cancers can even spread to the placenta, like melanoma. The chemotherapy used in the cancer may also have an effect on the foetal bone marrow. Planning the timing of the delivery is very important,” explains Dr Rossouw.

WHAT’S THE PLAN?

The main aim for your healthcare provider will be to screen for complications and then to plan risk-reducing management strategies. This sounds complicated, but really, what it means is that your doctor will assess any possible complications and work out the best healthcare schedule to protect your pregnancy as far as possible. While a ‘normal’ or lowrisk pregnancy seldom needs extensive testing or investigations apart from a few blood tests, including blood group, high-risk patients will see their healthcare provide far more regularly. For example, a diabetic patient is likely to see their healthcare provider every two weeks for the entire duration of their pregnancy. Patients are also likely to have specific tests at specific times in their pregnancy. Make sure you’re comfortable with your healthcare provider, because you will be seeing them a lot if you’re having a high-risk pregnancy!