You have heard what no pregnant woman wants to hear; your pregnancy has been labeled as high risk. Though the diagnosis is very scary, in the vast majority of cases, everything will turn out just fine. Once you have been given that disturbing label, it’s time to take stock and decide with your doctor’s help how you will best manage your pregnancy.
I can clearly remember the moment when I became high risk. I was sitting in my OBGYN’s office as she measured my stomach. My doctor was a woman of little words, and she cut right to the chase. “Ultrasound. Now.”
I was 34 weeks pregnant with my first child, and I waddled rather than walked to the ultrasound room. The doctor said nothing as she moved the wand over my swollen stomach, measured my son’s abdomen, leg bone, and head circumference. I didn’t know enough to be worried. She printed out a couple of pictures, which she handed me, and then left. I followed her back to the exam room. She told me, rather bluntly, that my son was too small for his age.
“You still working?” she asked.
I nodded. I’d left a class of eighth grade English students with a sub, working on vocabulary, to come to the appointment.
“Not anymore,” she said. She began to fill out a piece of paper.
“Can I just finish the week?” I asked her.
“No. Modified bed rest.” She handed me the paper. It was doctors orders which dictated the remainder of my pregnancy. I was to stay in bed all day, getting up only for the bathroom or to get something to eat. I was to eat–a lot. I was to come back in one week for a non-stress test, and in two weeks for an ultrasound.
“If that baby doesn’t gain a pound, then we have a baby.”
That baby. That’s my son, my Benjamin, I thought. Suddenly, I was afraid.
I spent the weeks in bed reading everything I could about being high-risk. What I read online was pretty scary. I also poured over the chapters in my pregnancy books about high-risk pregnancies and premature births. Bed rest was fun for two days and mostly interminable for the others.
That baby didn’t gain a pound in those two weeks (although I gained three), and I was induced at 35 weeks, 6 days. My son was small at 4 pounds 14 ounces, but he was healthy.
Five years later, pregnant with my daughter, I was classified as high risk simply because I already had a high risk pregnancy. I actually looked forward to bed rest, since I had two children at home already and I was dead on my feet every day after work. But I didn’t end up in bed this time around. I went all the way to my due date.
My introduction to the world of high risk pregnancies was certainly scary, but I did learn a lot
What is a High-Risk Pregnancy?
A high-risk pregnancy is one in which a woman has one or more of the following factors which put her and her unborn child at a greater risk of complications:
Age: The “average” global age for having a child is between the ages of 16 and 34. Anything outside of this range automatically puts a woman into the high risk category.
A pregnancy in a girl under the age of 16 is more likely to result in a baby with low birth weight, because of poor weight gain or poor nutrition, or other problems. Usually, these are due to a lack of prenatal care or maternal stress. The vast majority of pregnancies to girls under the age of 16, in the United States at least, are accidental. Many times these girls are less likely to seek a doctor’s care or take prenatal vitamins which increases the risk of birth defects, especially spinal cord defects such as spina bifida.
There is more controversy surrounding the upper age of the spectrum. Many women feel that the age of 35 is too young to be considered Advanced Maternal Age (AMA). It is not uncommon for a woman to wait until her thirties to start a family. In fact, one out of five women in the United States has her first baby after the age of 35. AMA puts a woman at a greater risk of having twins and increases the incidences of birth defects such as Down’s Syndrome. When a woman is 25, t he probability of having a baby with Down’s Syndrome is one is 1,250 births. When a woman is 49 or over, the risk goes up to one in 10.
I was definitely well inside this range with both of my children, being 24 with my first and 29 with my last. However, age is the most common reason women are classified as high risk.
Weight: While there are different complications inherent in women who are underweight (BMI under 18) and overweight (BMI over 25), both cases will land a woman into the high risk category.
Being underweight while pregnant is associated with a risk of low birth weight and premature babies. However, if an underweight woman is able to gain the proper amount of weight, and most doctors recommend gaining between 28 and 40 pounds, the risk of complications is returned nearly to normal.
Being overweight while pregnant is mainly associated with two main risks, gestational diabetes and high blood pressure. Gestational diabetes is when the pregnant woman’s body had trouble managing blood sugar levels. Untreated or not properly managed gestational diabetes can result in a baby who is large, which in turn increases shoulder dystocia and other labor difficulties, often leading to cesarean births. High blood pressure can lead to a condition called preeclampsia, which is characterized by chronic high blood pressure and protein in the urine. Preeclampsia, if not managed correctly, can cause swelling, migraine headaches, and even seizures. The only cure for preeclampsia is delivery. Preeclampsia is responsible for many premature births each year; however, with medications and bed rest, preeclampsia can usually be controlled.
I had what is sometimes termed as a “silent” case of preeclampsia with my first pregnancy. Because my blood pressure never went out of the normal range, the first symptom I presented with was my baby being too small for his gestational age. I was lucky in that I did not get preeclampsia–though ironically I did have some high blood pressure reading.
Problems with the baby or with the placenta: Often diagnosed by ultrasound, anomalies in the baby you are carrying, or the placenta (which is the baby’s support system) can be very scary. If there is any sign of something not right, the doctor will label you as high risk and most likely order further testing. This can include both physical and chromosomal problems in the baby, and conditions like placenta previa (where the placenta grows over the cervix) and placental abruption (where some or all of the placenta comes away from the wall of your uterus.)
Previous Pregnancies: If a mother has had problems in previous pregnancies, she will often be labeled as “high risk” at the very start of her pregnancy. The good news in these cases is that the mother and her obstetrician are often away of the previous problems and are monitoring the pregnancy closer from the beginning. A previous history of any of the following is enough to get labeled as “high risk”:
- Preterm birth or labor
- Previous cases of preeclampsia or gestational diabetes or other pregnancy-induced conditions such as hyperemesis gravidarum
- A child born with a birth defect
- A previous stillbirth or miscarriage after the first trimester
- A previous “high risk” pregnancy
Health History: If a mother-to-be has a chronic or serious illness, or a family history of a serious illness, she will also be in the “high-risk” category. These illnesses include, but are not limited to, lupus, any form of cancer, Type I or II Diabetes, fibroids, asthma, seizure disorders, heart disease, bleeding or clotting disorders, high blood pressure and mental or emotional disorders such as depression or schizophrenia. In addition, a serious injury sustained in the past, especially to the spinal cord or uterine area, will lead to a diagnosis of “high risk” in each pregnancy.
Management of High Risk Pregnancies: Some general good advice
In the majority of cases, high risk simply means extra monitoring. If you have been diagnosed as high risk, it is vitally important that you keep all your obstetrician appointments and make sure to discuss any changes in how you feel with your doctor immediately. Also very important is monitoring what you are putting in your body. Make sure you eat a healthy diet. Include fruits, vegetables, and protein unless you are advised differently by a doctor. Also, make sure you take a good prenatal vitamin containing both iron and at least 400 milligrams of folic acid. Don’t drink alcohol or smoke cigarettes, as is general good advice with any pregnancy.
If your obstetrician thinks that you need more focused care, he or she will send you to a perinatologist, also called a maternal-fetal medicine specialist. A perinatologist is a doctor who specializes in high risk pregnancies, and he or she can help further guide your care.
Sometimes, as in my case, you can do everything right and still be marked as high-risk. Honestly, being marked this way made me feel like I had done something wrong until I read further and realized just how many pregnancies fall into this category. But my outcome, as with the huge majority of women in my situation, was positive. After all, I have the children to show for it. Both babies came home from the hospital with me, and are now nine and four. I’m not advocating ignoring a diagnosis of high risk pregnancy, but I am advocating staying calm. Getting upset about something you cannot change is not going to help anything.
Besides, it is very obviously the baby who is in charge.
