High-Risk Pregnancy? Reduce Your Risks With Early Action

Make sure you’re healthy, be mindful of past experience

pregnant woman with picture of baby
The term “high-risk pregnancy” sounds frightening. But the good news is that healthy behaviors and early testing can help you stay out in front of problems with your pregnancy. You actually have a chance to reduce some of those “high risks.” A high-risk pregnancy usually has at least one out of these issues:
  • A disease the mother already has (diabetes or high blood pressure)
  • A problem with the fetus (birth defects or genetic conditions)
  • A problem unique to pregnancy that leads to complications (like premature labor)
“Any of those three things will increase the risk for adverse outcomes for mom, baby, or both.” says Jeff Chapa, MD, Head of the Section of Maternal-Fetal Medicine in Cleveland Clinic Children’s Hospital Department of Obstetrics and Gynecology. But Dr. Chapa adds that there are steps patients can take to reduce their risks in all three cases:

1. Treat the disease you already have

Women should address medical conditions that can affect a pregnancy up front. Common examples include diabetes, high blood pressure, heart disease, kidney disease and lupus. “To give the best chance for a successful and healthy pregnancy, it’s best if these conditions are under control before a would-be mom becomes pregnant,” Dr. Chapa says. “For anybody who has a pre-existing medical condition, it’s important to plan on having children and get pregnant only after you’ve gotten your underlying medical condition(s) appropriately treated and optimized your baseline level of health.” For example, Dr. Chapa says, “If you’re a diabetic, get your blood sugars under control. If you have high blood pressure, make sure you’re being appropriately treated.” “It’s the same thing with heart disease: make sure your heart is working well and ready for pregnancy. Pregnancy is a stress test for the body in many ways, and along with treating underlying medical conditions, getting into shape through weight loss, a healthy diet, and a regular exercise program before getting pregnant can lead to better results.”

2. Test for birth defects and genetic conditions

“Fetal problems that complicate pregnancies include birth defects and genetic conditions, such chromosome abnormalities,” Dr. Chapa says. The risks of chromosomal abnormalities increase as women get older, but anyone can have an affected child. The risk for some birth defects and genetic conditions may be increased based on family history or a woman’s ethnic background, and this should also be considered. Obstetricians use ultrasound and new, noninvasive ways (blood tests) that can detect such issues early in pregnancy. “It’s important to speak to your doctor or a genetic counselor early in pregnancy to learn about your risks and testing options,” he says. Finally, taking a prenatal vitamin pill, and in some cases extra folic acid, prior to and during early pregnancy can reduce the risks for many types of birth defects.
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3. Prevent complications you’ve had before

In a first pregnancy, obstetrical complications directly related to your pregnancy — such as preterm labor/birth or preeclampsia – are difficult to predict, Dr. Chapa says. But those who have had such problems should be especially on alert in later pregnancies, and women can take steps to prevent those complications from happening again. “If you’ve had a prior spontaneous preterm birth, you should take progesterone, which has been shown to reduce future risk,” he says. “Likewise if you have had preeclampsia, particularly when it occurs early in pregnancy, you can take aspirin, which has been shown to prevent a recurrence of that condition. For that group of people, getting in early and getting started on preventative treatments can help improve outcomes.” Pregnancy complications like gestational diabetes or preeclampsia also are proverbial canaries in a coal mine, Dr. Chapa says. Research shows a statistically greater likelihood of matching health problems later in life. “Of the women who have gestational diabetes, many will have [type 2] diabetes within 10 years,” he says. “Many of those who get preeclampsia are at risk of developing high blood pressure and heart disease later in life.” “Pregnancy complications identify people who are at greater risk for disease later in life, and that provides an opportunity to make changes and take preventative measures.”

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