High-Risk Pregnancies : What You Should Know (video/podcast)

Learning you are pregnant can bring both overwhelming joy and a bit of anxiety. You want your pregnancy and delivery to go as smoothly as possible, and with proper care, most do. Still, some pregnancies need more medical attention than others, especially if yours is a high-risk pregnancy.

In this video, San Diego Health host Susan Taylor talks about high-risk pregnancy care with Sean Daneshmand, MD, an OB-GYN and medical director of maternal and fetal medicine at Scripps Clinic, and Caitlin Grandfield, a prenatal genetic counselor at Scripps.

A high-risk pregnancy is a condition where the mother, her developing baby, or both could have any pregnancy-related complications. A pregnancy may be considered high-risk for a number of reasons, including:

• Having pre-existing conditions, such as high blood pressure
• Endocrine disorders, such as diabetes or thyroid abnormalities
• Autoimmune disorders, such as lupus or rheumatoid arthritis
• Being age 35 or older
• Being significantly overweight or obese

Complications also may develop during the pregnancy. Preeclampsia, for example, develops when blood pressure rises during pregnancy and increases the risk of serious problems such as seizures. Diabetes that develops during pregnancy, called gestational diabetes, is another potential high-risk condition.

A pregnancy also may be considered high-risk if the growing baby has medical issues, says Dr. Daneshmand.

“It could be premature labor or delivering earlier than 37 weeks of gestation,” he says. “It could also be fetal conditions, such as congenital abnormalities with the baby, or fetal growth restriction where the baby is not growing very well.”

Placental abnormalities are another possibility. The placenta is an organ that passes oxygen and nutrients between mother and baby; if something happens to disrupt this, the baby’s health could be at risk.

If you are planning to become pregnant, Dr. Daneshmand advises first meeting with your OB-GYN or family medicine primary care physician to discuss your medical and surgical history, family health history, medications and other information that may be relevant to pregnancy. The goal is to optimize your health prior to getting pregnant and decrease the risk of complications during pregnancy.

If you do have a high-risk pregnancy, your doctors will monitor you and your baby more closely. Your care team will include a maternal and fetal medicine physician who specializes in high-risk pregnancy care and will thoroughly track your baby’s development.

“Fetal imaging with ultrasound is a big part of what we do. We take a very detailed assessment of your baby in the early first trimester, anywhere between 11 to about 14 weeks, and then again around 20 weeks,” explains Dr. Daneshmand. “We also have fetal diagnostic procedures, such as genetic testing, and procedures to make sure that the baby and the mom are both doing well and are carrying the pregnancy to term.”

One common fetal diagnostic procedure is amniocentesis, which is typically performed between 16 to 21 weeks of gestation. During this procedure, a needle is inserted through the abdomen into the uterus, where it draws out amniotic fluid to be tested for genetic conditions such as chromosomal abnormalities.

Genetic counselors are health care professionals who provide education and support to patients before conception or during pregnancy. They can also help determine if a pregnancy may be high-risk and, if necessary, order and interpret genetic screening tests.

“We screen for general genetic conditions such as Down syndrome or cystic fibrosis,” explains Grandfield. “We look for congenital abnormalities or differences in the way that the baby is formed that could or could not be associated with a genetic condition, as well as those at risk for a familial condition.”

A familial condition means that there is a family history of the issue, such as a heart defect or cystic fibrosis, and the child may have an increased risk of developing it, while a genetic condition is passed from parent to child.

If you have any concerns about genetic or familial conditions, Grandfield recommends speaking with a genetic counselor before becoming pregnant to talk about family risks and screening.

“Everyone wants to have a healthy child, a healthy pregnancy, and learning that you have a high-risk pregnancy can cause lots of anxiety,” says Dr. Daneshmand. “Here at Scripps perinatology our team of genetic counselors and physicians can really help explain your diagnosis and help you make a plan.”

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