Maternal-Fetal Medicine at RWJBarnabas Health
What Is a High-Risk Pregnancy?
A high-risk pregnancy is one that carries a greater-than-normal risk of complications. Your doctor may consider your pregnancy high-risk if you:
- Are pregnant with multiple babies (twins or triplets, for example)
- Are a teenager
- Were older than 35 when your baby was conceived
- Have a history of pregnancy complications
- Have a medical condition such as heart disease, high blood pressure, diabetes, obesity, substance use disorder, a sexually transmitted disease or an autoimmune disorder
- Are pregnant with a baby who has been diagnosed as having a birth defect
- Have a family history of genetic disease
If your pregnancy is determined to be high risk, your doctor will need to monitor you closely. Your care plan will likely include more frequent checkups, imaging or other tests to make sure that all remains well with you and your baby as the pregnancy progresses.
RWJBarnabas Health’s obstetricians, gynecologists and maternal-fetal medicine (MFM) specialists (also called perinatologists) can advise you on care plans and strategies that will give you the best chance for a healthy pregnancy and delivery.
Twins, Triplets and Other Multiples
You may a higher chance of carrying multiple babies if you:
- Are over the age of 30
- Are taking fertility drugs
- Have had in vitro fertilization (IVF) treatments
A routine ultrasound in the first trimester will determine if you are pregnant with more than one child.
Carrying multiple children increases your risk for:
- Premature labor (before 37 weeks of pregnancy)
- Preeclampsia
- Gestational diabetes
- Fetal growth issues
You'll also have a greater chance of needing a caesarean section. Multiples are likely to be smaller for their size than single birth infants and may have difficulty breathing after birth.
If you are pregnant with multiple babies, your doctor will carefully monitor your progress and your babies' development throughout your pregnancy to provide the best possible outcome.
Pregnancy and Heart Disease
During pregnancy, a woman’s heart works extra hard pumping blood for two bodies instead of one. Her total blood volume increases between 30 and 50 percent, her heart rate may rise, and her blood pressure may fall. This puts additional stress on the heart that isn't normally there outside of pregnancy.
Preexisting conditions like congenital heart defects could also make women more vulnerable to complications during pregnancy. For example, women with heart defects may have a higher risk for anemia, hemorrhage or high blood pressure. They will need careful monitoring throughout the pregnancy.
If you have a heart condition, talk with your doctor about the special precautions and monitoring you may need.
Read more about pregnancy and heart disease.
Pregnancy and High Blood Pressure
Hypertension (high blood pressure) can lead to serious health complications for both mother and baby.
The two main types of hypertension are:
- Chronic hypertension. High blood pressure that was present before a woman becomes pregnant or that occurs in the first half (before 20 weeks) of pregnancy.
- Gestational hypertension. High blood pressure that first occurs in the second half (after 20 weeks) of pregnancy. Although gestational hypertension usually goes away after childbirth, it may increase the risk of developing hypertension in the future.
The effects of hypertension range from mild to severe and may include:
- Fetal growth restriction. High blood pressure can decrease the flow of nutrients to the baby through the placenta.
- Preeclampsia. In severe cases, some women develop preeclampsia, which is when the increased blood pressure affects organ function. This condition is more likely to occur in women with chronic high blood pressure than in women who usually have normal blood pressure outside of pregnancy.
- Preterm delivery. If the placenta can't provide enough nutrients and oxygen to your baby, your doctor may decide that early delivery is better for your baby than allowing the pregnancy to continue.
- Placental abruption. This condition, in which the placenta prematurely detaches from the wall of the uterus, is a medical emergency that requires immediate treatment. If you experience heavy bleeding during your pregnancy, whether you have hypertension or not, seek emergency care or dial 911.
- Cesarean delivery. Women with hypertension are more likely to have a cesarean delivery than women with normal blood pressure.
Pregnancy and Obesity
Obesity may cause or worsen complications during pregnancy. Women who are obese may be at greater risk for preeclampsia, hypertension and gestational diabetes. The chances of a stillbirth are higher, as is the potential need for a caesarean delivery. Obese mothers may also require longer hospital stays after delivery.
Gestational Diabetes
Gestational diabetes, or diabetes during pregnancy, is diabetes that first develops when a woman is pregnant. This is not the same as the chronic forms of diabetes but the risks are similar.
All pregnant women are screened for gestational diabetes. Glucose tests will typically be scheduled between 24 and 28 weeks of pregnancy, but it may be necessary to test earlier for women with risk factors. Gestational diabetes occurs most often in women who:
- Have a family history of diabetes
- Previously had a baby who weighed more than nine pounds
- Have had a miscarriage
- Are older than 25
- Have had a stillbirth in a previous pregnancy
- Are African American, American Indian, Asian American, Hispanic, Latina or Pacific Islander
- Are overweight
Uncontrolled gestational diabetes increases the risk for preterm labor and delivery, preeclampsia, and high blood pressure.
Many women with gestational diabetes can have healthy pregnancies if they manage their condition, which typically includes following a diet and treatment plan from their health care provider. In some cases, glucose-lowering medication or insulin injections may be necessary for the health of the baby. This is especially true in the later weeks of pregnancy, when insulin resistance is naturally at its highest point.
Depending on your blood sugar levels throughout your pregnancy, your personal medical history and the appearance of your baby and placenta on imaging tests, your doctor may advise inducing labor early to avoid complications and poor outcomes at birth.
Get Superior High-Risk Pregnancy Care at RWJBarnabas Health
If your pregnancy is considered high risk, choosing an experienced maternal-fetal medicine doctor and receiving regular prenatal care are incredibly important steps you can take for your health and the health of your baby.
Consider the hospital where you would like to deliver your baby. Is it equipped with a top-notch neonatal intensive care unit (NICU) if your baby needs extra care after birth? What is the ratio of nurses to patients?
RWJBarnabas Health maternity centers have state-of-the-art technology and expert medical staff that will help you achieve the best possible outcome. Our maternal-fetal medicine specialists are equipped to handle any emergency for mothers and babies before, during and after delivery. Learn more about maternity care at RWJBarnabas Health.
Find a doctor today or request a maternity tour at an RWJBarnabas Health hospital.
