High-Risk Pregnancy (Perinatology) and Risk Factors, Complications, and Treatment

Pregnancy is a period during which the health of both the mother and the fetus must be closely monitored.

During pregnancy, several changes occur in the mother's body to ensure optimal development and growth of the fetus. Pre-existing conditions in the mother or new issues that arise during this period can lead to serious complications in pregnancy. The high likelihood of complications arising from either the mother or the fetus indicates that the pregnancy is high-risk. Perinatology is a field that deals with high-risk pregnancies.

What is a High-Risk Pregnancy?

A high-risk pregnancy occurs when a person giving birth develops various health issues either before or during pregnancy. Additionally, chromosomal disorders and structural anomalies in the fetus can also lead to a pregnancy being considered high-risk. Perinatology, also known as maternal-fetal medicine, is the field of obstetrics that closely monitors pregnant individuals who are at risk due to various factors, conducting detailed tests to assess the health of the mother and fetus. Obstetricians specializing in perinatology provide services for the management of high-risk pregnancies.

What Causes Risky and High-Risk Pregnancies?

High-risk pregnancies can arise from health issues related to the mother, the fetus, or both. Conditions that may contribute to a high-risk pregnancy include:

• Pre-existing health issues in the mother
• Disorders that develop during pregnancy
• Risky lifestyle choices, such as tobacco, alcohol, and drug use
• Being over 35 years old or under 17 years old

Pre-existing maternal health conditions can increase the likelihood of complications during pregnancy. Common conditions include:

• Autoimmune diseases such as lupus and multiple sclerosis
• Diabetes
• High blood pressure
• Kidney disease
• AIDS
• COVID-19
• Severe underweight (a Body Mass Index of less than 18.5)
• Obesity
• Mental health disorders such as depression
• Thyroid diseases
• Polycystic Ovary Syndrome (PCOS)
• Blood clotting disorders
• Structural abnormalities in the uterus, such as fibroids

Just like pre-existing conditions, certain situations that develop during pregnancy can also increase the risk of complications. Some of these conditions include:

• Structural abnormalities or genetic disorders in the fetus
• Developmental delays in the fetus
• Gestational diabetes
• Multiple pregnancies
• Eclampsia or preeclampsia
• Complications from previous pregnancies, such as premature birth

What Are the Signs and Symptoms of High-Risk Pregnancy?

In high-risk pregnancies, certain symptoms may arise in the mother. These symptoms can develop in the context of a serious condition that may threaten life. Therefore, pregnant individuals showing one or more of the following symptoms should seek medical attention without delay:

• Persistent abdominal pain
• Chest pain
• Dizziness, fainting
• Extreme fatigue
• Decreased or halted fetal movements
• Fever above 38 degrees Celsius
• Heart palpitations
• Severe nausea and vomiting
• Persistent or worsening headache
• Swelling, redness, or pain in the face and limbs
• Thoughts of self-harm or harm to the fetus
• Shortness of breath
• Vaginal bleeding

At What Age Is Pregnancy Considered High Risk?

Age is a factor that carries risks in advanced maternal age pregnancies. A pregnancy is considered high risk if the mother is older than 35 or younger than 17.

Pregnant individuals over 35 have a higher likelihood of complications such as gestational diabetes and preeclampsia. In those under 17, issues such as anemia, sexually transmitted diseases, and premature birth are more frequently encountered. Additionally, there is a higher likelihood of inadequate prenatal and postnatal care for candidates under 17, which is another reason pregnancies may be deemed high risk.

What Are the Possible Complications of High-Risk Pregnancy?

High-risk pregnancies can face complications that pose a life threat. Potential complications associated with high-risk pregnancies include:

• Preeclampsia: Preeclampsia is characterized by high blood pressure in the mother during pregnancy. Problems such as developmental delays in the fetus, premature birth, and placental placement disorders may arise in pregnancies affected by preeclampsia. Pregnancies with preeclampsia must be closely monitored.
• Eclampsia: Eclampsia refers to the condition that occurs when a pregnant person diagnosed with preeclampsia experiences seizures. Eclampsia can seriously threaten both maternal and fetal health, requiring immediate treatment and close monitoring of the mother.
• Preterm Birth: Preterm, or early birth, occurs when labor happens before the 37th week of pregnancy. Babies born prematurely are more likely to experience respiratory distress and developmental delays.
• Cesarean Delivery: Cesarean delivery involves accessing the uterus through an incision in the mother's abdomen to deliver the baby. It carries a higher risk of complications compared to normal vaginal delivery.
• Excessive Bleeding During Delivery: Some bleeding during delivery is normal. However, in high-risk pregnancies, the amount of bleeding during and after delivery may be excessive, which can endanger the mother’s life.
• Low or High Birth Weight: Term (full-term) infants weighing less than 2500 grams are considered low birth weight, while those weighing over 4000 grams are considered high birth weight. Each condition carries its own specific risks.
• Structural Anomalies: The likelihood of structural anomalies developing in the fetus is higher in high-risk pregnancies. Conversely, the presence of a structural disorder in the fetus can categorize the pregnancy as high risk.
• Miscarriage or Stillbirth: Problems related to either the mother or the fetus in high-risk pregnancies can result in miscarriage or stillbirth.

Prevention and Treatment of Pregnancy Complications

Protecting the health of both the mother and baby is the primary goal in high-risk pregnancies. Therefore, those experiencing high-risk pregnancies must be closely monitored by a perinatologist throughout the pregnancy. The perinatologist may utilize the following methods to monitor maternal and fetal health during this process:

• Detailed Ultrasound: Detailed ultrasound allows for the assessment of the fetus in the womb for possible structural abnormalities. Early detection of a structural anomaly can help in correcting the issue or preventing further progression of the anomaly.
• Blood and Urine Tests: Conditions such as preeclampsia, diabetes, and thyroid disorders that may create high-risk pregnancy situations can be identified through blood and urine tests.
• Genetic Testing: If there is suspicion of a genetic syndrome in the fetus, genetic screening can be performed using samples taken from both the fetus and the parents.
• NST (Non-Stress Test): NST is a method used to monitor fetal heart rates and uterine contractions, also utilized in low-risk pregnancies. In high-risk pregnancies, NST is conducted earlier and more frequently.

Treatment for high-risk pregnancies is based on the underlying cause of the risk. For example, a mother with diabetes must have her blood sugar levels monitored throughout the pregnancy. In cases of high-risk pregnancies due to fetal structural anomalies, the fetus is closely monitored until delivery, after which surgical intervention may be planned to correct the relevant anomaly, ensuring the baby receives care in a neonatal intensive care facility if necessary.

To prevent complications associated with high-risk pregnancies, parents carrying risk factors should consult an obstetrician before birth and seek genetic counseling if necessary. Planning the pregnancy can reduce the likelihood of health problems during the pregnancy.

Today, a significant portion of pregnancies fall into the high-risk category. However, with close monitoring and treatment, it is possible to avoid serious complications related to high-risk pregnancies. Women planning to conceive or currently pregnant should definitely consult a well-equipped hospital, and if needed, seek care from a perinatologist.