How can I tell if I’ll have a high-risk pregnancy?

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Expert:Sarah Little, MD, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital

A pregnancy is considered a high-risk pregnancy if the mother or baby has a higher risk of complications. This can happen due to a variety of factors:

  • Maternal age
  • Pre-existing conditions
  • Conditions occuring during pregnancy
  • Multiple births – twins, triplets or more

Maternal age is one common factor that can categorize a pregnancy as high-risk.

Teenage mothers are more likely to have an unplanned pregnancy. They also often have inadequate prenatal care, as well as an increased risk of postpartum depression.

Older women, also face an increased risk of complications. Thirty-five and above is considered ‘advanced maternal age’ by medical professionals.

Why do older women have high-risk pregnancies?

Chromosomal abnormalities such as Down syndrome are more likely to occur with advancing maternal age. While the risk of conceiving a baby with Down syndrome is 1 in 1,250 at age twenty-five, the risk is 1 in 100 at age forty. Older moms are also more likely to miscarry than younger pregnant women. The increased risk of chromosomal abnormalities and miscarriage is due to decreasing egg quality in older women.

Older women, especially those over 40, also have a higher risk of medical complications during a pregnancy. These complications include:

  • pregnancy-induced hypertension
  • gestational diabetes
  • placenta previa

However, many women over age 35 go on to have healthy pregnancies. Doctors who specialize in high-risk pregnancies can help monitor older moms and counsel them about how to increase their chances of having a healthy pregnancy.

Pre-existing medical conditions can also lead to a high-risk pregnancy

Age is one important reason that a pregnancy might be considered high risk. However, pre-existing conditions (medical conditions you have before becoming pregnant) is another common factor. For example, women with the following conditions often require additional supervision and care during their pregnancy to manage increased risk:

  • diabetes
  • hypertension
  • autoimmune disease such as lupus
  • epilepsy
  • depression

Conditions occurring during pregnancy

Some women may develop conditions during pregnancy that require special treatment. A short cervix, a baby who is measuring small, and too much or too little amniotic fluid, are examples of complications that would categorize a pregnancy as high-risk.

Multiple births also involve higher risk

Lastly, pregnancies involving twins, triplets and higher order multiples are considered high-risk. 

A pregnancy may be high-risk for several reasons since many of the factors for high-risk pregnancy overlap. Twin pregnancies are common in older mothers, for example. Carrying multiples is also associated with hypertension.

If your physician decides that you have a high-risk pregnancy, you may be referred to one or more specialists. They can help monitor you throughout pregnancy and advise you on how to increase your chances of having a healthy pregnancy and baby. 


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