High-Risk Pregnancy

Healthcare providers use the term “high-risk pregnancy” to describe a situation in which a mother, her fetus, or both are at higher risk for problems during pregnancy or delivery than in a typical pregnancy.

A high-risk pregnancy may be one that involves chronic health problems, such as diabetes or high blood pressure; infections; complications from a previous pregnancy; or other issues that might arise during pregnancy.

NICHD is one of many federal agencies working to improve pregnancy outcomes, including research on the causes and management of high-risk pregnancies.

About High-Risk Pregnancy

A high-risk pregnancy is one in which the mother, her fetus, or both are at higher risk for health problems during pregnancy or labor than in a typical pregnancy.

For example, women who have chronic health problems, such as high blood pressure or diabetes, who become pregnant may be considered to have high-risk pregnancies—even if the condition is well controlled. Other factors, such as infections, injuries, and disorders of pregnancy, can also put a pregnancy at high risk.

Women whose pregnancies are considered high risk may need specialized care or treatment to have healthy pregnancies and deliveries. The specific type of care needed will depend on the specific risk factors, as well as the overall health of the mother and the fetus.

Just because a pregnancy is considered high risk does not mean that a problem will occur.

What are some factors that make a pregnancy high risk?

Several factors can make a pregnancy high risk, including existing health conditions, the mother’s age, lifestyle, and health issues that happen before or during pregnancy.

This page provides some possible factors that could create a high-risk pregnancy situation. This list is not meant to be all-inclusive, and each pregnancy is different, so the specific risks for one pregnancy may not be risks for another. Women who have any questions about their pregnancy should talk to a healthcare provider.

For the latest information on COVID-19 and pregnancy, visit CDC at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html.

Citations

  1. American College of Obstetricians and Gynecologists. (2018). FAQs: Preeclampsia and high blood pressure during pregnancy. Retrieved October 31, 2018, from https://www.acog.org/Patients/FAQs/Preeclampsia-and-High-Blood-Pressure-During-Pregnancy 
  2. Office on Women's Health. (2016). Polycystic ovary syndrome (PCOS) fact sheet. Retrieved February 6, 2017, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html
  3. National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Pregnancy if you have diabetes. Retrieved February 6, 2017, from https://www.niddk.nih.gov/health-information/diabetes/diabetes-pregnancy
  4. Williams, D., & Davison, J. (2008). Chronic kidney disease in pregnancy. BMJ, 336(7637), 211–215. Retrieved February 8, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213870/
  5. National Kidney Foundation. (2016). Pregnancy and kidney disease. Retrieved February 6, 2017, from http://www.kidney.org/atoz/content/pregnancy.cfm 
  6. Kendrick, J., Sharma, S., Holmen, J., Palit, S., Nuccio, E., & Chonchol, M. (2015). Kidney disease and maternal and fetal outcomes in pregnancy. American Journal of Kidney Diseases, 66(1), 55–59. Retrieved March 8, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485539/
  7. Office on Women's Health. (2012). Autoimmune diseases fact sheet. Retrieved February 6, 2017, from http://womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.html
  8. Office on Women's Health. (2017). Thyroid disease fact sheet. Retrieved February 6, 2017, from https://www.womenshealth.gov/a-z-topics/thyroid-disease
  9. Vesco, K. K., Sharma, A. J., Dietz, P. M., Rizzo, J. H., Callaghan, W. M., England, L., et al. (2011). Newborn size among obese women with weight gain outside the Institute of Medicine recommendation. Obstetrics & Gynecology, 117, 812–818.
  10. Institute of Medicine. (2009). Weight gain during pregnancy. Retrieved on February 6, 2017, from http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy-Reexamining-the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf  (PDF 716 KB)
  11. American College of Obstetricians and Gynecologists. (2012). FAQs: HIV and pregnancy. Retrieved February 6, 2017, from http://www.acog.org/~/media/For%20Patients/faq113.pdf?dmc=1&ts=20120730T1640322605  (PDF 279 KB)
  12. American College of Obstetricians and Gynecologists. (2015). FAQ 103: Having a baby (especially for teens). Retrieved February 6, 2017, from http://www.acog.org/Patients/FAQs/Having-a-Baby-Especially-for-Teens 
  13. American Academy of Pediatrics. (2015). Teenage pregnancy. Retrieved February 6, 2017, from http://www.healthychildren.org/English/ages-stages/teen/dating-sex/pages/Teenage-Pregnancy.aspx 
  14. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). (2007). Older mothers more likely than younger mothers to deliver by caesarean. Retrieved February 6, 2017, from http://www.nichd.nih.gov/news/releases/pages/caesarean_release_030807.aspx
  15. Gill, S. K., Broussard, C., Devine, O., Green, R. F., Rasmussen, S. A., Reefhuis, J.; The National Birth Defects Prevention Study. (2012). Association between maternal age and birth defects of unknown etiology: United States, 1997–2007. Birth Defects Research. Part A, Clinical and Molecular Teratology, 94(12), 1010–1018. Retrieved February 20, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532312/
  16. Grande, M., Borrell, A., Garcia-Posada, R., Borobio, V., Muñoz, M., Creus, M., et al. (2012). The effect of maternal age on chromosomal anomaly rate and spectrum in recurrent miscarriage. Human Reproduction, 27(10), 3109–3117. Retrieved February 8, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/22888165
  17. Sivalingam, V. N., Duncan, W. C., Kirk, E., Shephard, L. A., & Horne, A. W. (2011). Diagnosis and management of ectopic pregnancy. Journal of Family Planning and Reproductive Health Care, 37(4), 231–240. Retrieved February 20, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213855/
  18. Centers for Disease Control and Prevention. (2018). Fetal alcohol spectrum disorders: Alcohol use in pregnancy. Retrieved October 1, 2018, from http://www.cdc.gov/ncbddd/fasd/alcohol-use.html
  19. Eckstrand, K. L., Ding, Z., Dodge, N. C., Cowan, R. L., Jacobson, J. L., Jacobson, S. W., et al. (2012). Persistent dose-dependent changes in brain structure in young adults with low-to-moderate alcohol exposure in utero. Alcoholism: Clinical and Experimental Research, 36(11), 1892–1902. Retrieved March 19, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/22594302
  20. NICHD. (2013). Tobacco, drug use in pregnancy can double risk of stillbirth. Retrieved March 19, 2018, from https://www.nichd.nih.gov/news/releases/Pages/121113-stillbirth-drug-use.aspx
  21. NICHD. (2016). Cigarette smoking during pregnancy linked to changes in baby's immune system. Retrieved March 19, 2018, from https://www.nichd.nih.gov/news/releases/122316-smoking-pregnancy
  22. Centers for Disease Control and Prevention. (n.d.). Pregnant? Don't smoke. Retrieved February 6, 2017, from http://www.cdc.gov/Features/PregnantDontSmoke/
  23. NICHD. (2016). Prenatal exposure to marijuana may disrupt fetal brain development, mouse study suggests. Retrieved March 19, 2018, from https://www.nichd.nih.gov/news/releases/Pages/
    031516-prenatal-exposure-marijuana.aspx
  24. MedlinePlus. (2015). Twins, triplets, multiple births. Retrieved February 6, 2017, from https://medlineplus.gov/twinstripletsmultiplebirths.html#cat1
  25. American College of Obstetricians and Gynecologists. (2016). FAQs: Preterm (premature) labor and birth. Retrieved April 25, 2018, from https://www.acog.org/Patients/FAQs/Preterm-Labor-and-Birth 
  26. Howard, E. J., Harville, E., Kissinger, P., & Xiong, X. (2013). The association between short interpregnancy interval and preterm birth in Louisiana: A comparison of methods. Maternal and Child Health Journal, 17(5), 933–939.

Can a high-risk pregnancy be prevented?

High-risk pregnancy is not always preventable. Some factors, such as chronic conditions and lifestyle factors, can be treated and controlled before pregnancy to help reduce risk. But some conditions aren’t treatable or, even if well controlled, still mean higher than normal risk. Other problems may start in pregnancy.

Staying healthy before and during pregnancy is a good way to lower the risk of having a difficult pregnancy. Healthcare providers recommend that women who are thinking about becoming pregnant visit a healthcare provider to make sure they are in good pre-pregnancy health.

Before and during pregnancy, a woman can take steps to help reduce her risk of certain problems.1 Visit the Pre-Pregnancy Care and Prenatal Care topic for more detailed information.

Citations

  1. Centers for Disease Control and Prevention. (2016). Folic acid: Recommendations. Retrieved February 19, 2018, from https://www.cdc.gov/ncbddd/folicacid/recommendations.html

How is high-risk pregnancy treated?

Treatment for high-risk pregnancy depends on the woman’s specific risk factors.

For example, treatment for a woman whose pregnancy is high risk because of a thyroid problem is usually medication to ensure her body has the right levels of thyroid hormones. Treatment for a woman whose pregnancy is high risk because of cigarette smoking is helping her to quit smoking. Treatment for a woman whose pregnancy is high risk because she is HIV positive would involve antiretroviral treatments during pregnancy, possibly a surgical delivery, and additional medications for her and the baby after birth.

In a high-risk pregnancy, healthcare providers will want to keep a close watch on the woman and the pregnancy to detect any potential problems as quickly as possible so that treatment can start before the woman’s or fetus’s health is in danger. This is particularly true of pregnancies that are high risk because of preeclampsia and previous preterm labor or birth. In these situations, treatment could mean additional days in the womb to allow for fetal development to continue.

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