High-Risk Pregnancy

Pregnancies in people older than age 35 or younger than age 17 are usually considered high risk due to factors ranging from inadequate prenatal care and lifestyle choices to how aging affects a woman’s reproductive system.

Pregnancy over age 35

Pregnant people older than 35 face a higher risk of gestational diabetes, high blood pressure and complications during childbirth, often leading to a higher likelihood of cesarean sections (C-sections). The need for C-sections can increase due to factors such as a decline in uterine muscle tone and an increased likelihood of fetal distress.

Pregnancy after age 35 can also increase a baby’s chances of developing chromosomal abnormalities, such as Down syndrome.

Pregnancy under the age of 17

Pregnant people younger than 17 are also considered high risk because adolescent bodies may struggle with the demands of pregnancy, leading to complications such as preterm birth, low birth weight and high blood pressure. In addition, emotional readiness for parenthood, lifestyle choices and potential challenges in accessing proper prenatal care also contribute to the risks.

Preexisting medical conditions can increase the risk of complications in your baby. If you have any of the following conditions, your OBGYN will want to monitor your health throughout your pregnancy so they can help you manage these conditions and protect you and your baby’s health.

• Autoimmune diseases: Autoimmune conditions, such as multiple sclerosis (MS) and lupus, can affect pregnancy outcomes, increasing the risk of miscarriage and preterm birth. The medications used to treat them can also impact a fetus, so be sure and talk with your doctor about any medication use during pregnancy.
• Blood disorders: Certain blood disorders, such as thrombophilia and sickle cell disease, can complicate pregnancy by increasing the risk of blood clots, anemia and other complications.
• Diabetes: Diabetes and high blood sugar during pregnancy can increase the risk of miscarriage and stillbirth. It can also increase your baby’s risk of birth defects, being born too large and having health problems at birth, as well as putting you at greater risk for high blood pressure and preeclampsia.
• High blood pressure: High blood pressure during pregnancy can lead to complications such as preeclampsia, a condition characterized by high blood pressure and organ damage. Preeclampsia poses risks of premature birth, low birth weight and complications for both the mother and the baby.
• HIV/AIDS: Pregnant people with HIV/AIDS face unique challenges, as the virus can be transmitted to the baby. However, antiretroviral therapy and medical monitoring can prevent mother-to-child transmission.
• Kidney disease: Preexisting kidney disease can increase the risk of complications, such as preeclampsia, preterm birth and low birth weight.
• Obesity: Obesity increases your likelihood of developing gestational diabetes, preeclampsia and complications during labor and delivery. It may also cause your baby to develop heart problems.
• Polycystic ovary syndrome (PCOS): PCOS is a hormonal disorder affecting the ovaries that can lead to an increased risk of gestational diabetes, preeclampsia and preterm birth.
• Previous pregnancy complications: While not a health condition, having a previous miscarriage or preterm labor can lead your OBGYN to consider your pregnancy as high-risk. Your OBGYN can identify an underlying cause or help you manage other risk factors that may contribute to these complications and help ensure your baby reaches full term.
• Thyroid disease: Uncontrolled thyroid disorders can impact your baby’s heart and brain development, so a high-risk pregnancy specialist can work with you to manage thyroid conditions with medicine.

You may have a high-risk pregnancy because of factors affecting your developing baby, from birth defects to genetic syndromes. Learning about these factors during pregnancy allows you and your maternal-fetal medicine specialist to anticipate complications during labor and delivery and begin planning your baby’s care before birth.

Birth defects: Some birth defects can significantly impact fetal health. Congenital heart defects, for example, are structural abnormalities in the heart present at birth. These conditions can affect blood flow and oxygen supply and require specialized medical attention soon after birth.

• Chromosomal and genetic conditions: Down syndrome (caused by an extra copy of chromosome 21), cystic fibrosis and fragile X syndrome (caused by a mutation on the X chromosome) are conditions that occur due to genetic or chromosomal abnormalities. They can cause health problems in babies, such as congenital heart defects, or require treatment as soon as your baby is born.
• Fetal anemia: Fetal anemia can lead to insufficient oxygen supply and hinder your baby’s development. The condition can occur for many reasons, including blood type incompatibility between you and your baby (Rh incompatibility).
• Fetal growth restriction: Fetal growth restriction occurs when the fetus does not reach the expected size, leading to complications during delivery and increasing your baby’s risk of health issues. If your baby does have one of these risk factors, rest assured that your care team will be there to guide you through your next steps. We’re here for you and your baby every step of the way.

Some factors and health problems develop during pregnancy that cause your OBGYN to classify a normal pregnancy as high risk. In many cases, identifying these pregnancy-related conditions allows your OBGYN or maternal-fetal medicine specialist to treat them or monitor you to protect your health and that of your baby.

• Depression: Maternal mental health, specifically depression during pregnancy, can contribute to preterm birth, low birth weight and developmental issues. Comprehensive support, including counseling and medical care, can help you address depression.
• Gestational diabetes: Gestational diabetes, a form of diabetes that develops during pregnancy, can lead to complications such as macrosomia (large birth weight), preterm birth and an increased chance of needing delivery by C-section. Managing blood sugar levels through diet, exercise and sometimes medication can help you address gestational diabetes and protect your baby’s health.
• Preeclampsia: Preeclampsia, characterized by high blood pressure that develops after 20 weeks and organ damage, poses serious risks to you and your baby. In severe cases, it can lead to a life-threatening condition called HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome.
• Pregnancy with multiples: Carrying twins, triplets or other multiples increases the risk of preterm birth, low birth weight and other complications. You will need regular monitoring and may need to deliver via C-section, especially if you have three or more babies.
• Twin-to-twin transfusion syndrome: Imbalances in blood flow can occur in pregnancies with identical twins sharing a placenta. This condition, called twin-to-twin transfusion syndrome, can result in developmental issues for both twins. Close monitoring and treatments, such as fetal surgery, may be necessary.

Beyond medical conditions, lifestyle factors play a pivotal role in your baby’s health and your health during pregnancy, labor and delivery. If you’re concerned about alcohol, tobacco or substance use during your pregnancy, ask your OBGYN about resources and support programs available to help you.

• Alcohol use: Drinking alcohol during pregnancy can lead to fetal alcohol spectrum disorders. This umbrella term encompasses a range of developmental and cognitive issues, including intellectual disabilities and physical abnormalities. Avoiding alcohol throughout your pregnancy is the best way to protect your baby.
• Tobacco use: Smoking exposes your developing baby to harmful substances, including nicotine and carbon monoxide, that can cause preterm birth, low birth weight, developmental issues and other complications. Quitting smoking helps protect you and your baby during, and long after, pregnancy.
• Substance use: Illicit drug use poses significant dangers during pregnancy. Substances such as cocaine, opioids and methamphetamine can lead to complications like preterm birth, neonatal abstinence syndrome and long-term developmental challenges for your baby.