#22 What Causes High Risk Pregnancies?

If you are pregnant, your obstetrician should tell you whether or not your pregnancy is considered high risk. This can be scary, but if you know why your pregnancy is considered high risk, you can learn how to lessen this risk as much as possible.

Pregnancies can be labeled high risk for a number of reasons. Are you under 19 or over 35? Are you having twins? Are you obese? Have you had invitro fertilization (IVF)? Do you have any autoimmune diseases such as lupus? Do you have high blood pressure? Or diabetes? Asthma?

If you find yourself with a pregnancy that your physician considers high risk, what can you expect about your prenatal care? You will probably be seeing your obstetrician more often than those women regarded as having low risk pregnancies. Your obstetrician should be monitoring your pregnancy closely, especially for signs for pre-eclampsia.

Your physician may run certain lab tests periodically to monitor your pregnancy. You may be checked for a urinary track infection several times during your pregnancy. You may have your urine checked several times to be sure there isn’t too much protein in it. You may have your creatinine levels checked as well as your blood urea nitrogen levels (BUN). Your obstetrician may even have you come in once or twice a week to have your blood pressure checked.

Blood pressure is relative. Be sure to know what your blood pressure normally runs when you are not pregnant so you can tell when your pressure goes significantly above normal for you when you were not pregnant. I often had my patients come to my office once or twice a week to check their blood pressures. Some women might find this tedious, but it is important. Actually, I recommend you take your blood pressure every day at home.

With a high risk pregnancy, your obstetrician will watch you closely for signs of pre-eclampsia by using the tests mentioned above, as well as blood tests for hemoglobin, platelets, and creatinine.

Sometimes your obstetrician may refer to you to a physician, called a perinatologist, who specializes in high risk pregnancies. You may also be referred to a neonatologist, a physician specializing in high risk babies. Neonatologists care for high risk babies up to six weeks old. Once your baby is over six weeks, you may be asked to continue to take your baby to a physician working with children considered high risk at birth. Pediatric intensivists take care of high-risk babies over six weeks old.

There are sometimes ways to lessen the risk to your pregnancy. Obviously, diabetes or autoimmune diseases cannot be eliminated in a pregnancy. However, your obstetrician should carefully monitor your medications for chronic diseases and be sure your treatment during pregnancy is appropriate. For example, some medications for diabetes or asthma are considered safer during pregnancy than others. Your obstetrician should review your medications and be sure you are on medications for your chronic conditions which are considered safe during pregnancy.

I recommend that if you are planning to become pregnant and you have chronic conditions which put you in the high-risk category during pregnancy, talk to your physician before you become pregnant. Your obstetrician can be sure your chronic disease such as asthma or diabetes are controlled optimally before you become pregnant. The goal is to go into your pregnancy with your chronic disease optimally controlled so you can come out of your pregnancy and delivery with your chronic diseases still well controlled.