High-Risk Pregnancy

What is a high-risk pregnancy?

All pregnancies carry risks. The definition of a “high-risk” pregnancy is any pregnancy that carries increased health risks for the pregnant person, fetus or both. People with high-risk pregnancies may need extra care before, during and after they give birth. This helps to reduce the possibility of complications.

However, having a pregnancy that’s considered high risk doesn’t mean you or your fetus will have problems. Many people experience healthy pregnancies and normal labor and delivery despite having special health needs.

How common is high-risk pregnancy?

About 50,000 people in the U.S. experience severe pregnancy complications each year. Overall, Black people are about three times more likely to die from pregnancy-related complications than white people.

What causes high-risk pregnancy?

Factors that make a pregnancy high risk include:

• Preexisting health conditions.
• Pregnancy-related health conditions.
• Lifestyle factors (including smoking, drug addiction, alcohol abuse and exposure to certain toxins).
• Age (being over 35 or under 17 when pregnant).

What are common medical risk factors for a high-risk pregnancy?

People with many preexisting conditions have increased health risks during pregnancy. Some of these conditions include:

• Autoimmune diseases, such as lupus or multiple sclerosis (MS).
• COVID-19.
• Diabetes.
• Fibroids.
• High blood pressure.
• HIV/AIDS.
• Kidney disease.
• Low body weight (BMI of less than 18.5).
• Mental health disorders, such as depression.
• Obesity.
• Polycystic ovary syndrome (PCOS).
• Thyroid disease.
• Blood clotting disorders.

Pregnancy-related health conditions that can pose risks to the pregnant person and fetus include:

• Birth defects or genetic conditions in the fetus.
• Poor growth in the fetus.
• Gestational diabetes.
• Multiple gestation (pregnancy with more than one fetus, such as twins or triplets).
• Preeclampsia and eclampsia.
• Previous preterm labor or birth, or other complications with previous pregnancies.

What are the signs and symptoms of high-risk pregnancy?

Talk to your doctor right away if you experience any of the following symptoms during pregnancy, whether or not your pregnancy is considered high-risk:

• Abdominal pain that doesn’t go away.
• Chest pain.
• Dizziness or fainting.
• Extreme fatigue.
• The fetus's movement stopping or slowing.
• Fever over 100.4°F.
• Heart palpitations.
• Nausea and vomiting that’s worse than normal morning sickness.
• Severe headache that won’t go away or gets worse.
• Swelling, redness or pain in your face or limbs.
• Thoughts about harming yourself or the fetus.
• Trouble breathing.
• Vaginal bleeding or discharge.

At what age is a pregnancy considered high risk?

People who get pregnant for the first time after age 35 have high-risk pregnancies. Research suggests they’re more likely to have complications than younger people. These may include early pregnancy loss and pregnancy-related health conditions such as gestational diabetes.

Young people under 17 also have high-risk pregnancies because they may be:

• Anemic.
• Less likely to get thorough prenatal care.
• More likely to have premature labor or birth.
• Unaware they have sexually transmitted infections (STIs).

What are the potential complications of high-risk pregnancy?

A high-risk pregnancy can be life-threatening for the pregnant person or fetus. Serious complications can include:

• Preeclampsia (high blood pressure from pregnancy).
• Eclampsia (seizure from pregnancy).
• Preterm delivery.
• Cesarean delivery (C-section).
• Excessive bleeding during labor and delivery, or after birth.
• Low or high birth weight.
• Birth defects.
• Problems with the fetus's brain development.
• Neonatal intensive care unit admission for your baby.
• Intensive care unit admission for you.
• Miscarriage.
• Stillbirth.

How is high-risk pregnancy diagnosed and monitored?

Getting early and thorough prenatal care is critical. It’s the best way to detect and diagnose a high-risk pregnancy. Be sure to tell your healthcare provider about your health history and any past pregnancies. If you do have a high-risk pregnancy, you may need special monitoring throughout your pregnancy.

Tests to monitor your health and the health of the fetus may include:

• Blood and urine testing to check for genetic conditions or certain congenital conditions (birth defects).
• Ultrasonography, which uses sound waves to create images of the fetus to screen for congenital conditions.
• Monitoring to ensure the fetus is getting enough oxygen, such as a biophysical profile, which monitors their breathing, movements and amniotic fluid using ultrasound, and a non-stress test, which monitors their heart rate.

How is high-risk pregnancy managed?

Management for a high-risk pregnancy will depend on your specific risk factors. Your care plan may include:

• Closer follow-up with your obstetrician.
• Consultation with a maternal fetal medicine (high-risk pregnancy) specialist.
• Consultation with other medical specialists.
• More ultrasounds and closer fetal evaluation.
• Home blood pressure monitoring.
• Careful monitoring of medications used to manage preexisting conditions.

If your health or the health of the fetus is in danger, your healthcare provider may recommend labor induction or a C-section.

How can I prevent a high-risk pregnancy?

You can reduce your risk of pregnancy complications by:

• Avoiding drugs and alcohol.
• Identifying potential health risks before getting pregnant. Tell your doctor about your familial and personal medical history.
• Maintaining a healthy body weight before pregnancy.
• Managing any preexisting health conditions you may have.
• Making sure any long-term medications are safe to take during pregnancy.
• Quitting smoking.
• Planning pregnancies between the ages of 18 and 34.
• Practicing safe sex.

What’s the prognosis (outlook) for people with high-risk pregnancy?

Many people who have high-risk pregnancies don’t experience any problems and deliver healthy babies. But they may be at a higher risk for health problems in the future, including:

• Complications during future pregnancies.
• Postpartum depression.
• High blood pressure.
• Cardiovascular disease.
• Type 2 diabetes.
• Stroke.

Some high-risk pregnancies can increase a child’s risk of:

• Behavioral problems.
• Breathing disorders.
• Gastrointestinal diseases.
• Growth and developmental delays.
• Mental health conditions.
• Neurological disorders.
• Obesity and diabetes.
• Vision, hearing or dental problems.

When should I contact my doctor?

It’s possible for pregnancy-related complications to occur up to six weeks after a pregnancy ends. Pay close attention to your health. Alert your healthcare provider right away if you notice anything abnormal.

A note from Cleveland Clinic

What does high-risk pregnancy mean? A variety of factors can make a pregnancy high risk. These include age and certain health conditions. If you have a high-risk pregnancy, you may need extra care before, during and after birth. Be sure to get thorough prenatal care. Stay in close communication with your healthcare provider to reduce your risk of pregnancy complications.