High-Risk Pregnancy

Diagnostic Criteria and Assessment

Women who are high risk can be identified as such during an early prenatal care evaluation to assess the health status of both mother and fetus, to estimate the latter's gestational age, and to outline a plan for continued prenatal care. Prenatal care should include a thorough medical history to identify specific risk factors, a complete physical examination, routing laboratory screenings for common disorders, and follow-up maternal and fetal assessments over the course of the pregnancy to attempt to minimize risk.

Epidemiology and Risk Factors

Preterm labor is the leading cause of perinatal morbidity and infant (neonatal) mortality.

Risk factors for preterm labor include younger or older maternal age (below 16 or over 35 years); low socioeconomic status; poor maternal nutrition; low maternal weight (below 110 lb); uterine, placental, or cervical abnormalities; smoking; substance abuse; infection; anemia; multiple gestation (being pregnant with more than one baby); and previous complications in pregnancy. Other preexisting health conditions such as gestational diabetes, heart disease, cancer, sexually transmitted diseases, chronic hypertension, or human immunodeficiency virus (HIV) may cause a high-risk pregnancy.

Gestational diabetes occurs exclusively in pregnant women and occurs in about five percent of all pregnancies in the United States. Although most women are able to control their diabetes through a careful regimen of diet, exercise, and monitored weight and blood sugar and give birth to healthy babies, untreated gestational diabetes can result in jaundice, hypoglycemia, mineral deficiencies, or respiratory distress in the infant.

Preeclampsia is a condition that causes hypertension and proteinuria (large amounts of protein being secreted in the urine) and occurs in about seven percent of pregnant women in the United States. Preeclampsia typically occurs midway through pregnancy and may be accompanied by swelling in the face and hands, abdominal pain, headache, and blurred vision. If left untreated, preeclampsia progresses to eclampsia, a more severe condition characterized by seizures that can be fatal. Although there is no cure for preeclampsia, in severe cases, delivery of the fetus is the only resolution. In more mild cases of preeclampsia, home treatment of bedrest and frequent assessment by a care provider may be recommended.

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