Some risk factors for pregnancy complications are present before women become pregnant. These risk factors include
Certain physical characteristics, such as age and weight
Problems in a previous pregnancy, including the need to have a cesarean delivery
Exposures that can harm the fetus
Some major risk factors are discussed here. For additional medical conditions that may complicate pregnancy, see Pregnancy Complicated by Disease.
Physical Characteristics
The following characteristics of women affect risk during pregnancy.
Age
About 13% of all pregnancies occur in adolescents (see also Adolescent Pregnancy). Adolescents are at increased risk of having the following conditions, which often leads to babies who are born underweight (small-for-gestational age):
Preeclampsia (a type of high blood pressure that develops during pregnancy)
Part of the reason for these risks is that adolescents are less likely to get medical care during pregnancy. Also, they are more likely to smoke cigarettes or use other substances, and they have higher rates of sexually transmitted infections. (Using condoms can help prevent sexually transmitted infections.)
Older age is also a factor in pregnancy complications. Women aged 35 and older are at increased risk of having the following:
A preexisting disorder that increases risk during pregnancy, such as high blood pressure or diabetes
Problems related to the pregnancy, such as preeclampsia, gestational diabetes (diabetes that develops during pregnancy), chromosomal abnormalities in the fetus, and stillbirth
Complications during labor, such as difficult labor or a placenta that detaches too soon (placental abruption) or is mislocated (placenta previa)
Children of women aged 35 or older are more likely to have birth defects, such as heart defects. a narrowed esophagus (esophageal atresia), a defect of the urethra called hypospadias, or a defect of the skull called craniosynostosis.
As women age, genetic counseling and testing for chromosomal and genetic abnormalities becomes more important. In older pregnant women, ultrasonography may be done to help determine whether the fetus has birth defects.
Weight
Women with a body mass index (BMI) of less than 19.8 (see table Body Mass Index) before becoming pregnant are considered underweight and are more likely to have
Small, underweight babies
Women with a BMI of 25 to 29.9 before pregnancy (overweight) and women with a BMI of more than 30 (obese) are more likely to have the following problems:
Very large babies (large-for-gestational age), which may be difficult to deliver
Babies who are born underweight (small-for-gestational age)
Babies with birth defects
Gestational hypertension (high blood pressure that first develops after 20 weeks of pregnancy)
Preeclampsia (gestational hypertension accompanied by protein in the urine)
A pregnancy that lasts 42 weeks or longer (postterm pregnancy)
Need for a cesarean delivery
Doctors encourage most women to exercise at least 3 times a week for a total of 150 minutes a week. Women should talk to their doctor about appropriate weight gain, diet, and exercise at the initial prenatal visit and periodically throughout the pregnancy.
Reproductive organ abnormalities
Structural abnormalities in the uterus or cervix increase the risk of the following:
A difficult labor
A miscarriage during the second trimester and preterm labor
Need for a cesarean delivery
Structural abnormalities include a double uterus, fibroids in the uterus, and a weak cervix (cervical insufficiency) that tends to open (dilate) as the fetus grows. Fibroids occasionally cause the placenta to be mislocated (called placenta previa), labor to begin too early (preterm labor), and miscarriages to occur. Cervical insufficiency increases the risk that a baby will be delivered too soon (preterm delivery).
Problems in a Previous Pregnancy
Women who have had a problem in one pregnancy are more likely to have the same problem in subsequent pregnancies. Such problems include any of the following:
Postterm delivery (after 42 weeks of pregnancy)
Hemolytic disease of the fetus and newborn that required a blood transfusion to the fetus
Small-for-gestational age or large-for-gestational age newborn
Cerebral palsy in the baby
Abnormal position of the fetus, such as buttocks first (breech)
Gestational diabetes
Preeclampsia (high blood pressure during pregnancy)
Shoulder dystocia: Baby whose shoulder gets caught in the birth canal during delivery, which sometimes injures the nerves in the baby's shoulder (brachial plexus injury)
Women who had a baby with a genetic disorder or birth defect are more likely to have another baby with a similar problem. Genetic testing of the baby, even if stillborn, and of both parents may be appropriate before another pregnancy is attempted. If these women become pregnant again, tests such as high-resolution ultrasonography, chorionic villus sampling, and amniocentesis may help determine whether the fetus has a genetic disorder or birth defect. These women may be referred to a specialist.
Having had 5 or more pregnancies increases the risk of very rapid labor and excessive bleeding after delivery.
Disorders Present Before Pregnancy
Before becoming pregnant, women may have a disorder that can increase the risk of problems during pregnancy. These disorders include
Kidney infections
Women who have one of these disorders should talk with a doctor and try to get in the best physical condition possible before they become pregnant. After they become pregnant, they may need special care, often from an interdisciplinary team. The team may include an obstetrician (who may also be a specialist in the disorder), a specialist in the disorder, and other health care practitioners (such as nutritionists).
Disorders During Pregnancy
During pregnancy, a problem may occur or a disorder may develop to make the pregnancy high risk.
Some disorders that occur during pregnancy are related to (are complications of) pregnancy. Other disorders are not directly related to pregnancy (see Pregnancy Complicated by Disease). Certain disorders are more likely to occur during pregnancy because of the many changes pregnancy causes in a woman's body.
Pregnancy complications are problems that occur during pregnancy. They may affect the woman, the fetus, or both and may occur at different times during the pregnancy. For example, complications such as a mislocated placenta (placenta previa) or premature detachment of the placenta from the uterus (placental abruption) can cause bleeding from the vagina during pregnancy. Women who have heavy bleeding are at risk of losing the baby or of going into shock and, if not promptly treated, of dying during labor and delivery.
Other pregnancy complications include
A previous miscarriage or stillbirth
An abnormally located pregnancy (ectopic pregnancy)
Severe nausea and vomiting during pregnancy (hyperemesis gravidarum)
A weak cervix (cervical insufficiency) that tends to open (dilate) as the fetus grows
Hemolytic disease of the fetus and newborn (when a pregnant woman has Rh-negative blood and the fetus has Rh-positive blood)
Problems with amniotic fluid (the fluid that surrounds the fetus in the uterus)
An infection of the tissues around the fetus, such as the amniotic fluid (intra-amniotic infection)
Preeclampsia (a type of high blood pressure that develops during pregnancy)
Multiple Gestation
Being pregnant with twins or more fetuses (multiple gestation) increases the risk of the following:
Underweight babies
A placenta that detaches too soon (placental abruption)
Birth defects
Stillbirth or death of the newborn
After delivery, vaginal bleeding in the mother
Multiple gestation is usually detected with ultrasound in the first trimester. Incidence of multiple gestations has been increasing; use of assisted reproductive technologies have contributed substantially to this increase.
Exposures During Pregnancy
Substances and conditions that increase the risk of birth defects are called teratogens. Birth defects are most likely to result if women are exposed to a teratogen 2 to 8 weeks after they become pregnant (4 to 10 weeks after their last menstrual period) because the fetus's organs are forming during this time. The risk of having a miscarriage is also increased.
During pregnancy, being exposed to the following can increase the risk of having a baby with a birth defect:
Certain infections
Certain substances and medications
Radiation and certain chemicals (such as carbon monoxide, lead, gasoline, and mercury)
Infections that are particularly dangerous during pregnancy include
Rubella (German measles)
Infections with cytomegalovirus, coxsackievirus, or parvovirus B19
Substances and medications that may increase the risk of birth defects include
Bath salts (cathinones)
Some prescription medications (see table Some Medications and Risk of Problems During Pregnancy)
Exposure to high temperatures (> 102° F [39° C ]), such as in a sauna or hot tub, during the first trimester has been linked to the development of spina bifida.
Mercury in seafood
Consuming too much mercury in seafood may harm the fetus. However, seafood contains nutrients that are important for growth and development of the fetus and for breastfed infants. Thus, the Food and Drug Administration (FDA) recommends the following for women who are pregnant, who may become pregnant, or who are breastfeeding:
Do not eat tilefish from the Gulf of Mexico, shark, swordfish, big-eye tuna, marlin, orange roughy, and king mackerel.
Limit the amount of albacore or yellowfin tuna eaten to 4 ounces (one average meal) a week.
Before eating fish caught in local lakes, rivers, and coastal areas, check local advisories about the safety of such fish, and if mercury levels in the fish are not known to be low or if no advice is available, limit the amount eaten to 4 ounces (one average meal) a week and do not eat other high-mercury seafood during that week.
Each week, eat 8 to 12 ounces (2 or 3 average meals) of a variety of seafood that is lower in mercury.
Tilefish from the Gulf of Mexico have the highest levels of mercury of all fish (as tested by the U.S. Food and Drug Administration (FDA), but tilefish from the Atlantic Ocean can be safely eaten.
Image from the U.S. Food and Drug Administration (FDA) and the United States Environmental Protection Agency (EPA).
Seafood that is lower in mercury includes flounder, shrimp, canned light tuna, salmon, pollock, tilapia, cod, and catfish (see Advice about Eating Fish For Those Who Might Become or Are Pregnant or Breastfeeding and Children Ages 1–11 Years).
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Centers for Disease Control and Prevention (CDC): Sexually Transmitted Diseases During Pregnancy: This web site provides links to a fact sheet about pregnancy and sexually transmitted infections (STIs), statistics (including links to the prevalence of different STIs and their effect on pregnant women and their infants), and links to treatment of different STIs. It also provides links to general information about pregnancy and STIs.
U.S. Food and Drug Administration (FDA): Advice about Eating Fish For Those Who Might Become or Are Pregnant or Breastfeeding and Children Ages 1–11 Years: This web site provides information that can help pregnant women (as well as other women and parents of young children) choose fish that are nutritious and safe to eat.
