High-risk pregnancy? Very high-risk pregnancy? What do these terms mean?

The correct medical terminology is “high-risk pregnancy”, and it involves a large number of different medical conditions. The one thing these conditions have in common is that they cause the pregnancy to be different, non-routine, and to require clos monitoring and more frequent follow-ups than other pregnancies.

What kind of doctor manages high-risk pregnancies?

A doctor who specialises in high-risk pregnancy is a gynecologist who has completed a subspecialty or further training in the management or treatment of such complex cases. High-risk pregnancies mean care is needed for both the mother and fetus. This is because both the mother and fetus are at risk throughout the pregnancy.

Who determines the criteria for a high-risk pregnancy and what kind of medical conditions make a pregnancy high-risk?

These criteria are usually set by local or national guidelines, and they are based on present definitions that are found in the medical literature.
As you will read below, these pre-set definitions have many implications, including financial consequences. In most medical settings, high-risk pregnancies are such pregnancies where there is a concern for one of the following conditions:

What are the different conditions that meet the criteria for a high-risk pregnancy?

Maternal age

Pregnant women under the age of 17 or over the age of 40 are considered to have a high-risk pregnancy.

Significant past medical history prior to pregnancy

High-risk clinics are visited by pregnant women who have medical conditions that can have an effect on the pregnancy, the health of the pregnant mother or the development of the fetus, hence the importance of the consults prior to the pregnancy.
Examples of such conditions are hypertension, diabetes, hypercoagulability, autoimmune disease, pre-gestational diabetes, inflammatory bowel disease, asthma, epilepsy, morbid obesity (BMI above 30), extreme underweight (BMI under 18) and many more.
Controlling these conditions well before the pregnancy usually brings about better outcomes during pregnancy.

Past obstetrical or gynecological history

Women who had complications during their previous pregnancies fall into this category. For example, a previous early delivery, eclampsia, gestational diabetes, previous small for gestational age baby, previous Cesarean section and more.
Sometimes there are interventions that can be carried out to try and prevent such complications from occurring or to identify them as soon as they start developing.

Present medical illnesses

High-risk clinics are visited by pregnant women who have conditions that present during the pregnancy itself or women who have complicated pregnancies that are considered high-risk to begin with. For example – a multiple pregnancy, short cervix, early labour, eclampsia, gestational diabetes, viral infections during pregnancy such as CMV, etc. To learn more about CMV infections during pregnancy follow the link here.

What does follow up at the high-risk unit include?

High-risk clinics offer consults prior to pregnancy as well as close follow up and care during pregnancy. This follow up is important and sometimes may be critical for a healthy mother and baby. The frequency of visits to this clinic and the tests required vary depending on the mother, her past medical history, the conditions she has and the pregnancy itself. An emphasis is placed on the tests advised such as amniocentesis, focused ultrasound scans or third anatomical scans, which is becoming more and more popular these days, and more.

What are the financial implications of high-risk pregnancies?

High risk pregnancies require closer monitoring. Prices of different tests may vary depending on your national health system.

Where can high-risk pregnancies be followed up?

This may vary in different countries around the world. However, high-risk pregnancies are usually followed up either in outpatient clinics, public hospitals, or private healthcare clinics/hospitals.

Should all pregnancies be considered high-risk?

All pregnancies are precious. Most pregnancies are normal, and routine follow-up is sufficient. However, when a pregnancy meets one of the criteria mentioned above, it is best to refer to a specialist for further care.

It is important to keep in mind that most high-risk pregnancies have good outcomes and result in healthy babies, following close monitoring and care. Therefore, I find it important to remain optimistic and think positive during the pregnancy.

In summary, I hope your pregnancy is as smooth as can possibly be. Should questions arise or should the pregnant women fall into one of the categories mentioned above and meet the criteria for high-risk pregnancy, I advise you to seek care with an experienced specialist, for the sake of your own health and your child’s health.