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Now, let me start off by saying that my pregnancy was not considered uneventful, but I also don’t personally consider it a “high risk” one, either. Sure, the last 4 weeks of my pregnancy were spent on early dismissal from the demands of ICU bedside nursing, and yes I saw a high-risk fetal medicine doctor every single week for being on “pre-eclampsia watch.” After my weekly OB appointment, I was sent downstairs to the docs with the big guns. They hooked me up to the external fetal monitoring set-up (for those who want technical terms: the tocodynamometer which measures uterine contractions/activity and the ultrasound transducer to monitor baby’s heart rate) then brought me into the ultrasound room for a quick scan to measure the placenta and amniotic fluid levels. But, after each appointment, everything seemed completely on track. I didn’t necessarily “feel” high-risk, even though we were labeled as such. 

That was me. However, going into a routine run-of-the-mill OB appointment can quickly turn any soon-to-be parent to panic-mode once your OB says with that concerned-but-trying-to-still-sound-upbeat tone, “well, just to be sure, we’re going to send you to high-risk fetal medicine to run some tests to make sure that {insert reason for concern} is okay…” Your OB may want you to see them immediately, the same day, or no later than the next day. Either way, thoughts of panic begin to flood your mind as the room starts spinning and you feel your face turn flush with anxiety. As your heart begins to race, you think to yourself, well if the baby’s heart rate wasn’t high enough before, it certainly must be NOW!

So What Does it Mean to be Considered “High Risk”?

Being considered a “high risk” pregnancy means that there may be reasons for concern that may lead to complications to the mother, baby, or both during your pregnancy. This means that your OB team will need to pay a little more attention to you and baby throughout your pregnancy, to ensure a healthy mom and safe delivery of a healthy baby. 

During visits to the obstetrician, your blood is drawn, urine sample analyzed, blood pressure and heart rate noted, and baby’s heart rate is monitored through a doppler device (the little external device they use to listen to your baby’s heart beat by moving a small handheld transducer over your belly). An internal vaginal exam is done. Later in your pregnancy, ultrasounds measure for the presence of baby’s important structures. These are all part of the standard visit to your OB and all these tests are done for very important reasons – to make sure everything is going smoothly and to detect any risks that you or baby may have that can put you at high-risk – “high alert” – throughout your pregnancy.

Those seemingly unimportant tests* are in fact, very important. Your blood pressure is checked for signs of pre-eclampsiaUrine screenings check for the presence of protein, glucose (sugar), and ketones to rule out gestational diabetes or pre-eclampsia.  Your blood is drawn to look for appropriate hormone levels, iron levels, kidney function, blood type, Rh factor, CMV infection, etc. to rule out nutrient deficiencies, problems affecting your organs, infections that can put baby and mom at risk, and for a mismatch of proteins in the blood between baby and mom. Vaginal exams check for progress in cervical changes during pregnancy that can raise flags to necessitate intervention like a cerclage (procedure where the cervix is stitched tighter if there is premature dilation), swab sample tests for STD’s, cervical cancer, Group B strep, etc. Ultrasounds are done to check for things like four heart chambers, presence of a nasal bone, important brain structures and proper bone formation. It checks to make sure the placenta is attached where it should be and that it is growing accordingly. If not, your baby may not receive optimal oxygen or nutrition, or the placenta can bleed or rupture prematurely. At a certain point, a glucose challenge and/or oral glucose tolerance test may be done to check for development of gestational diabetes that occurs in 

This is why prenatal care throughout the entire duration of your pregnancy (as soon as you suspect you are pregnant, but preferably before you plan to get pregnant) is associated with better outcomes in successful deliveries of healthy babies.

*certain special voluntary tests can also be done, such as chorionic villi sampling, cordocentesis, triple/quad screening, amniocentesis, and nuchal translucency tests. These check for additional factors, but these are not required or necessary in all cases. Some tests carry risk to baby. For more info, speak with your OB. 

The Risks For Being High-Risk

Women can be pre-disposed to a high-risk pregnancy (meaning, mom already has a medical condition or characteristic that is considered a risk factor prior to becoming pregnant) or they can develop a high risk medical condition during pregnancy.

Risk factors can include:

  • Advanced maternal age (35 and older)
  • Certain lifestyle choices
    • cigarette smoking (risks for low birth weight baby, miscarriage, premature delivery, birth defects, SIDS, deadly maternal blood clots (deep vein thrombosis), poor oxygenation and nutrition to baby, pregnancy-induced osteoporosis)
    • alcohol consumption
    • illicit drug use (birth defects, decreased fetal movement, developmental delays, to name a few)
  • Medical History (prior c-section, history of deep vein thrombosis (blood clots in the deep veins in the leg or pelvis) during pregnancy, low-birthweight, or preterm labor, genetic conditions, prior fetal demise or death shortly after delivery)
  • Underlying conditions prior to pregnancy (obesity, high blood pressure, kidney disease, diabetes type 1 or 2, epilepsy, anemia, certain heart conditions, infection (HIV, hepatitis C, CMV, chickenpox, syphilis, toxoplasmosis, etc), mental health condition such as depression, etc)
  • Conditions developed during pregnancy (polyhydraminos – too much amniotic fluid, oligohydraminos – too little amniotic fluid, slow fetal growth, pre-eclampsia, eclampsia, placental attachment abnormalities, Rh+/- mismatch between baby and you)
  • Multiples (twins, triplets, etc) 

What Does it Mean For Me?

Being considered “high risk” means that you’ll visit your regular OB more frequently, to note the progression of your risk factor(s) throughout the rest of your pregnancy. If your blood pressures or blood sugars are high, for instance, they’ll be able to monitor these more closely. You may have to do some at-home monitoring. You also may be scheduled for more frequent ultrasounds to check for baby’s growth, placenta, and amniotic fluid. (Note: I looked at this as more opportunities to get extra take-home ultrasound pictures of Jia for my scrapbook)

You may be referred to a high-risk fetal specialist, and/or another type of specialist, like endocrinologist (a doctor that specializes in conditions in the endocrine glands, like if you are diabetic or are diagnosed with gestational diabetes), rheumatologist (rheumatic diseases like rheumatoid arthritis), hematologist (if you have a blood condition or are being treated for blood clots), or cardiologist during your pregnancy. 

Moving Forward

Be aware of your risk factors.

If you can change your risk factors, then start immediately (modifiable factors like lifestyle choices – smoking, smokers in the home, alcohol use, illegal drug use or misuse of prescription medications, etc.). If you are obese or overweight, talk to your OB and physician about losing weight prior to becoming pregnant. If you are already pregnant, you and your OB will monitor for appropriate weight gain during pregnancy, since weight loss during pregnancy is not advised. 

Being considered a high-risk pregnancy can definitely be scary. But knowledge is power.

The more you and your OB know about you and your baby’s growth, the better. Being labeled as “high risk” can most definitely be considered a good thing – you and baby will get the extra attention you need to make sure you both are healthy by the end of your last trimester, and keep in mind – the extra attention could mean that you may go home with extra snapshots to stick to the fridge!

As always, talk to your doctor if you have any concerns. And make sure you schedule your first prenatal appointment with your OB/GYN as early into your pregnancy as possible (preferably before you become pregnant)!

Sources

High Risk Pregnancy from the Mayo Clinic: http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/high-risk-pregnancy/art-20047012

The Centers for Disease Control and Prevention – Tobacco Use During Pregnancy http://www.cdc.gov/reproductivehealth/tobaccousepregnancy/

Northern Virginia’s Physicians to Women – High Risk Pregnancy:  http://nvpwomen.com/womens-health/healthwise/?DOCHWID=uf9705#uf9706

March of Dimes Prenatal Care and Prenatal Tests http://www.marchofdimes.org/pregnancy/prenatal-tests.aspx

Thank you to Lindsey Frank of The Tiny Collection for your absolutely stunning maternity photo with Baby #2 on the way! She and baby are high risk and high-level of sweetness! 

Photo Credit: David Abel Photography