Overview of High-Risk Pregnancy

In a high-risk pregnancy, the mother and/or the fetus or neonate are at increased risk of morbidity or mortality before, during, or after delivery.

High-risk pregnancies are characterized by conditions that potentially pose a threat to the health of the mother and/or the fetus or neonate. Risks can result from various factors such as chronic disease, multiple gestation, previous pregnancy complications, or nonobstetric or obstetric complications that arise during a pregnancy.

Clinicians should screen for these risk factors at a preconception visit or early in prenatal care. For women planning to become pregnant, preconception assessment and counseling can help identify potential risk factors.

Clinicians should discuss potential risk factors, including preexisting medical conditions (eg, diabetes, hypertension, thyroid disorders, psychiatric disorders), previous pregnancy complications, and genetic factors. Clinicians review the patient's medications and nutritional supplements to address drug safety in pregnancy and determine if any medications or supplements need to be discontinued, adjusted, or changed. Disease management should be optimized for conditions that are known to cause adverse fetal or maternal effects if poorly managed (eg, diabetes, hypertension, hypothyroidism). Modifiable risk factors, such as smoking, alcohol and drug use, and weight management, should be discussed. If either potential parent has a known or suspected genetic abnormality, the couple should be referred for genetic counseling and testing. Additionally, counseling should include discussions on the importance of folate supplementation, immunizations, and optimizing overall health before conception.

High-risk pregnancies require close monitoring, specialized care, and a multidisciplinary medical team, and sometimes referral to a perinatal center. Perinatal centers offer many specialty and subspecialty services provided by maternal, fetal, and neonatal specialists (1). Close monitoring throughout the pregnancy may involve management of chronic diseases and increased frequency of prenatal visits, blood tests, and ultrasonography and other types of fetal monitoring. Communication with the pregnant woman and her family is essential to involve the patient in shared decision-making, develop a care plan, and provide emotional support.