Overview

What is a high-risk pregnancy?

Your pregnancy is called high-risk if you or your baby has an increased chance of having a health problem. These problems include slowed growth of the baby, preterm labour, preeclampsia, and a problem with the placenta. Many things can make a pregnancy high-risk, from a current condition such as diabetes to a problem in a past pregnancy.

Being called "high-risk" doesn't mean that you or your baby will have problems. It's just a way for doctors or midwives to make sure that you get special attention during your pregnancy. But if there are any problems, this extra attention will help your doctor or midwife find them early.

What makes a pregnancy high-risk?

Many things can make a pregnancy high-risk. In general, your pregnancy may be high-risk if:

• You have certain health problems. These problems include diseases such as diabetes or high blood pressure, an infection such as HIV, or other health problems such as a heart valve disease.
• You are younger than 17 or 35 or older.
• You smoke or vape, drink alcohol, or take certain medicines.
• You've had problems in past pregnancies, such as preterm labour, preeclampsia, or three or more miscarriages.
• You are carrying more than one baby (multiple pregnancy), or your baby has a problem, such as Down syndrome or a heart, lung, or kidney problem.

How will your doctor care for you during your pregnancy?

You'll need to see your doctor or midwife more often than you would if your pregnancy wasn't high-risk. It's important that you go to every appointment. These visits can help your doctor or midwife find and treat any problems early.

You may see a doctor who has extra training in high-risk pregnancies. This type of doctor is called a maternal-fetal specialist, or perinatologist. You may see both this doctor and your regular doctor or midwife. Or the specialist may be your doctor throughout your pregnancy.

Talk to your doctor or midwife about where you should give birth. If your health or your baby's health could be at risk, you may need to have your baby early. Your doctor or midwife may want you to have your baby in a hospital that can handle an emergency caesarean section and has a neonatal intensive care unit (NICU).

What prenatal exams and tests are done during a high-risk pregnancy?

At each prenatal visit, your doctor or midwife will do a physical exam. Your doctor or midwife will also do tests to look for any signs of problems. If problems are found early, treatment can help you and your baby stay healthy.

Tests done during a high-risk pregnancy include:

• Blood pressure checks to monitor for high blood pressure or preeclampsia.
• Blood testing to check for low iron (anemia).
• A urine test and urine culture to check for a urinary tract infection (UTI).
• Transvaginal ultrasound to assess the risk of preterm labour.
• Fetal ultrasound to monitor the baby's growth and amniotic fluid.
• An oral glucose screen done early in pregnancy and in the second trimester to check for gestational diabetes.

You may also have tests to check for genetic conditions and birth defects, especially if you are 35 or older or if you had a genetic problem in a past pregnancy. Ask your doctor or midwife about your testing options.

What can you do to help have a healthy pregnancy?

• Go to all your prenatal visits. You will have tests for high blood pressure and for protein in your urine (both are signs of preeclampsia). Your doctor or midwife also will make sure that your baby is growing properly.
• Follow your doctor or midwife's directions for activity. You may have to reduce your activity or spend a lot of time resting (partial bedrest).
  • Ask your doctor or midwife if you need to change your work activities. Your doctor or midwife can write your employer a note about work activity changes you may need. The doctor or midwife can also talk to you about your options for medical leave if needed.
  • If your doctor or midwife places you on partial bedrest, gently stretch your legs every hour to keep good blood circulation. And keep a phone, notepad, and pen near the bed where you can easily reach them.
• If you are told to take medicine, such as medicine for high blood pressure, take your medicine exactly as prescribed. Call your doctor, midwife, or nurse advice line if you have any problems with your medicine.
• Follow your doctor or midwife's advice for diet and other tips for a healthy pregnancy. Rest when you need it, eat well, and drink plenty of water. If you are not on partial bedrest, do mild exercise (such as walking) if your doctor or midwife says it is okay.
• Do not smoke or vape. They can harm your baby's growth and health. If you need help quitting, talk to your doctor or midwife about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Do not drink alcohol or use cannabis or other drugs. They can cause problems in the growing baby. If you need help quitting, talk to your doctor or midwife.
• Avoid chemicals and radiation (such as from X-rays). Stay away from people who have colds and other infections.
• Your doctor or midwife may ask you to count your baby's movements, such as kicks, flutters, or rolls. Once each day, time how long it takes to count 6 movements. If you don't feel at least 6 movements in 2 hours, call your doctor, midwife, or nurse advice line.