High-risk pregnancy: Reducing your risk is in your hands

Have you ever wondered why certain pregnancies are considered high-risk? While it is true that all pregnancies carry some risks, some pregnancies are more high-risk than others.  A pregnancy is considered high risk when it requires special care and attention because of a problem with the pregnancy itself, a preexisting maternal health condition, fetal congenital disability complications, or a combination of these factors. 

A pregnancy is prevalent. In fact, at The Medical City, 6 of every ten women who give birth have a high-risk pregnancy. According to the Department of Health figures in 2018, about 100 women die for every 100,000 live births in the Philippines because of complications during pregnancy. 

How will you know if you have a high-risk pregnancy? There are pregnancy-specific problems that make a pregnancy at higher risk for complications. This includes recurrent pregnancy loss or miscarriages, a history of preterm birth in a previous pregnancy, abnormally high blood pressure or hypertension, and  bleeding at any time during pregnancy. Women with medical risk factors existing before pregnancy have increased health risks. Some of these conditions include:

• Autoimmune diseases, such as lupus
• COVID-19
• Diabetes
• Hypertension
• Kidney disease
• Heart disorders
• Low body weight (BMI of less than 18.5)
• Obesity (BMI of 35 or more)
• Thyroid disease
• Blood clotting disorders
• Brain and psychiatric conditions

Conditions that can pose risks to the unborn baby and to the woman include:

• Congenital disabilities or genetic conditions
• Fetal growth problems such as inadequate growth, or overgrowth (macrosomia)
• Pregnancy with twins, triplets, and more
• Alloimmunization (a condition in which mothers develop antibodies that can cross the placenta and attack fetal red blood cells)

In addition to these risk factors, the mother’s age also influences the pregnancy outcome. Research suggests that women who get pregnant for the first time after age 35 are more likely to have complications than younger women. These complications may include early pregnancy loss and pregnancy-related health conditions such as gestational diabetes and hypertension during pregnancy. In addition, young women under 17 are also more likely to have high-risk pregnancies.

The detection of a high-risk pregnancy is critical. This is because various complications may occur in a woman with a high-risk pregnancy, and these complications depend on the present health condition. Severe complications include miscarriage, stillbirth, death of the baby inside the womb, and even maternal death. 

However, having a high-risk pregnancy does not always mean you or your unborn baby will have problems. Many people experience healthy pregnancies and normal labor and delivery despite having special health needs. 

Zarinah G. Gonzaga, MD, FPOGS, FPSMFM, FPSUOG is a subspecialist in Maternal-Fetal Medicine and in Ultrasound in Obstetrics and Gynecology. She is currently the Director of the Institute for Women’s Health (IWH), The Medical City. She is also the Assistant Secretary and the Chair of the Committee on Continuing Medical Education of the Philippine Society of Maternal-Fetal Medicine (PSMFM).

Early and thorough prenatal care is the best way to detect and diagnose a high-risk pregnancy. The management of a high-risk pregnancy calls for a multidisciplinary team care approach. Your obstetrician may refer you to a Maternal-Fetal Medicine or High-Risk Pregnancy Subspecialist, as well as a Medical Specialist, depending on your specific risk factors.  You will need a closer follow-up with your healthcare team. Other management that you can expect include:

• Close monitoring of your symptoms, blood pressure, blood sugar levels or other clinical parameters depending on your health condition
• Careful monitoring of medications used to manage preexisting health problems
• First-trimester screening, to check for genetic conditions or specific congenital disabilities 
• Ultrasound, to screen for congenital disabilities, track the baby’s growth, and detect amniotic fluid volume 
• Fetal monitoring tests to detect if the baby is getting enough oxygen, such as nonstress test, biophysical profile and Doppler flow studies

If you have preexisting health problems, it is best to avoid potential health risks before getting pregnant to reduce your risk of pregnancy complications. You can do this by:

• Maintaining a healthy body weight
• Quitting smoking
• Avoiding drugs and alcohol
• Managing any preexisting health conditions with a medical specialist
• Make sure any long-term medications are safe to take during pregnancy
• Planning pregnancies between the ages of 18 and 34

If you are currently pregnant and you think you have risk factors, remember that there are ways in which you can ensure optimal health for you and your unborn baby. At the first prenatal visit, be sure to tell your obstetrician about your health history and any past pregnancies. Be sure to get thorough prenatal care. 

Stay in close communication with your obstetrician and your medical specialists. Follow up with your healthcare team regularly and make sure to take their advice about monitoring and medications. It is also essential to plan your childbirth with your obstetrician to ensure your condition is carefully monitored during labor and delivery. If your unborn baby is suspected of having a congenital disability, planning where to give birth is important to ensure that your newborn receives timely and adequate care. 

It is also possible for pregnancy-related complications to occur up to six weeks after pregnancy. After you have given birth, pay close attention to your health. Alert your healthcare provider right away if you notice anything abnormal. 

Care for the high-risk pregnancy

The Medical City’s (TMC) Institute for Women’s Health (IWH) provides the highest level of specialized care, counseling, and diagnostic services for women with high-risk pregnancy with our board-certified maternal-fetal medicine (MFM) subspecialists. 

IWH offers comprehensive screening for preeclampsia at any trimester during pregnancy. Preeclampsia is one of the most common complications affecting pregnant women in the Philippines. “Be Seen, Get Screened” is an ongoing preeclampsia screening program at TMC-IWH. It helps detect a woman’s risk for preeclampsia early in pregnancy. It enables OB-Gynecologists to start measures that can help prevent the complications of this condition for the mother and her baby. 

IWH also provides advanced antenatal fetal surveillance tests for women with high-risk pregnancies to ensure fetal well-being. For women requiring inpatient monitoring of their condition, IWH offers the Maternal Intensive Care Unit, which provides intensive one-on-one monitoring for both mother and baby. Our MFM subspecialists collaborate with a team of subspecialists in Obstetric Anesthesia, Neonatology, Internal Medicine, and other fields.

ADVT.