High Risk Pregnancies

What does high risk pregnancy mean?  What determines if a pregnancy is high risk?
High risk pregnancies fall into three groups.  One group is high risk because women carry a particular diagnosis or something from her history makes her high risk; either they’ve had previous complicated pregnancies or they’ve had a kidney or heart transplant, or carry a diagnosis of lupus.  The next group is related to the babies; mom gets pregnant with twins or triplets, or they go to the ultrasound and find something complicated about the pregnancy related to the baby.  The last group is entities that can develop in pregnancy; the pregnancy begins as low risk, and then rarely, but it can happen, they develop complications with the pregnancy.

Does the pregnancy cause health risks or do pre-existing health risks cause pregnancy concerns?
It really can be both.  When we think about pre-existing conditions, typically in our first counseling session with patients and families, we talk about how those conditions could impact the pregnancy and how the pregnancy itself can affect the conditions. We used to think that pregnancy was a negative thing, but we’ve come to learn that most pre-existing conditions, especially with women who are optimized with regards to those conditions, do very well during pregnancy.  Pregnancy itself is associated with some risks. Women can develop high blood pressure or a form of diabetes during pregnancy when they’ve never had those issues before.

What specific factors might contribute to a high risk pregnancy?
As it relates to moms, the most common things these days that complicate pregnancies are forms of diabetes, high blood pressure, women who are heavier than they’d like to be when they become pregnant and just about any medical condition that patients carry or runs in their families. We really enjoy seeing patients and families even before they get pregnant to talk about any increased risks to a pregnancy, and outline a plan so they know what pregnancy would look like for them, and what sort of additional testing and monitoring we would recommend.

It’s comforting to know that we’re seeing a lot better diagnosis and preparation for high risk pregnancy than we did 20 years ago.
That’s absolutely true. We see so many patients who were treated for things in their infancy or childhood, and were told that they wouldn’t be able to carry a pregnancy or that it would be too dangerous. But medicine and our understanding and knowledge have really advanced, and it’s nice to be able to tell the vast majority of those patients that in fact, it is safe for them to carry a pregnancy and they can have really positive outcomes.

What is a maternal fetal medicine doctor, and who do the typically treat?
I went to medical school and then after that, I did my specialty training in OB-GYN.  After that, I did my sub-specialty training in maternal fetal medicine.  Really, all I do is take care of pregnant women or see them before they are anticipating becoming pregnant.  We also have additional training in advanced ultrasound techniques, and we specialize in complicated deliveries, and in genetic diagnosis during pregnancy. We are the sub-specialty that also does some of the procedures for babies while women are still pregnant.