Pregnancy is a normal physiological process, a phase of life to be enjoyed and to be cherished. However, pregnancy is also a stressful condition for the body, both physically, mentally, and can be emotionally challenging. While most pregnancies go smoothly, a few underlying health issues or some new development can make it high risk, requiring special care, rest, investigations, etc. High risk pregnancy is one in which due to some factors there is a greater risk to the baby or the mother or both. Some factors which make the pregnancy high risk are;

• MATERNAL AGE – Pregnancies at the extremes of age like teenage pregnancy or beyond the age of 35 are at higher risk of developing complications. There is a higher chance of miscarriage and birth defects, especially if you are above the age of 35. Mothers who are more than 35 years of age are also at risk of developing gestational diabetes, pregnancy-induced hypertension, preterm labor.
• PRE EXISTING MEDICAL CONDITIONS – If you already have any pre-existing medical condition like diabetes, high blood pressure, heart disease, kidney disease etc., you are at a higher risk of developing complications during pregnancy. Some of these problems worsen in pregnancy. You will require expert handling during pregnancy and at the time of delivery. Some of these problems may impact fertility as well. These issues may also require expert medical control even at the time of conception. Some of them may also need a change in medication before pregnancy occurs. For example, if you are suffering from diabetes, your sugars need to be well controlled before you get pregnant as very high sugar level at the time of pregnancy can lead to abnormal babies.
• PREVIOUS BAD OBSTETRIC HISTORY – if you have had past abortions, preterm deliveries ( delivery before 37 weeks), stillbirth, intrauterine death ( baby died inside the womb) , etc., your pregnancy will require expert handling and intensive care. The care should ideally start before pregnancy. You may need further investigations to understand the cause of such a loss, folic acid supplement, treatment of any pre-existing medical condition, etc. During pregnancy; you may need rest, injections, and supportive therapy.
• ISSUES DURING THE CURRENT PREGNANCY – Certain conditions which develop during the current pregnancy will increase the risk in this pregnancy, like developing high blood pressure, gestational diabetes (developing diabetes in the pregnancy), twins, low lying placenta, etc. These pregnancies require extensive care and multidisciplinary approach.

WHAT CAN YOU DO?

Consult an expert gynaecologist before you get pregnant

If you are planning to become pregnant, you should definitely talk to an experienced gynecologist with expertise in high-risk pregnancy cases. She may advise you to attain a healthy weight before pregnancy begins and may ask you to start having folic acid along with a prenatal vitamin every day. You should stop smoking and alcohol before you get pregnant. If you possess a medical concern, the doctor might adjust your treatment or change your treatment to prepare you for pregnancy. For example, there are certain blood pressure medicines which are safe in pregnancy while others are not. You will require certain tests to ensure that you are in good health to get pregnant like haemoglobin, blood sugar, thyroid etc. Appropriate medicines will be started according to the reports. You may require certain tests based on your previous pregnancy history. Besides that, the gynecologist will explain in detail about the risks for you and the baby.

Treat your pre-existing medical condition

If you already have a medical issue such as lupus, kidney disorder, high blood pressure, heart disorder or diabetes, it is vital that you plan a pregnancy only after you have made sure that these underlying medical problems are getting proper treatment and you are in the best health for getting pregnant. For example, if you have diabetes, make sure that the sugar levels are controlled or if you have hypertension, ensure that it is controlled suitably. This will ensure best possible outcome in pregnancy.

Test for genetic disorders and birth defects

At the very beginning of your pregnancy, have a detailed discussion with your gynecologist regarding the tests available to rule out any abnormalities in the baby.  Some non-invasive tests and ultrasounds help in the early detection of any problem. Folic acid can help lower the risk of some forms of birth defects if taken before or during your early pregnancy.

Prevent complications you have developed before

Pregnancy-associated complications such as birth defects, preterm labor, or preeclampsia are quite unpredictable in the case of a first pregnancy. But you can take some precautionary measures for preventing recurrence in your subsequent pregnancies. For example, aspirin can be started early if you have had preeclampsia, progesterone can help decrease preterm birth risks. Certain lifestyle changes like healthy diet can also make a difference.

Improve your lifestyle

Take the following lifestyle measures to lower your high-risk pregnancy possibilities: Have a healthy diet You would require more iron, calcium, folic acid, and other important nutrients during pregnancy. Please ensure that you maintain all these nutrients in your diet. Avoid risky substances You must quit smoking altogether. Fully avoid substances such as illegal drugs, alcohol, and tobacco. Discuss with your gynecologist regarding any prescribed or non-prescribed supplements or medications that you are currently taking. Check your weight Proper weight gain can aid in supporting your baby’s health and growth. Consult your doctor regarding the ideal amount of weight gain and try to maintain your weight within that limit. Go for regular prenatal visits Regular visits help in the monitoring of your health and the baby’s growth. Problems, if any, can be detected early. Timely detection and early treatment can make a world of difference in the outcome of pregnancy. Remember, A stitch in time saves nine. The doctor may recommend visiting an expert in pediatrics, maternal-fetal medicine, genetics, etc. as per your condition.

Sensible use of technology

If you require Assisted Reproductive Technology (ART), consider the number of embryos to be transferred. IVF can result in multiple pregnancies which can causes

Choose your gynaecologist and place of delivery

All high risk pregnancies require expert and trained obstetrician. Correct guidance, requisite tests, appropriate treatment can make a difference to pregnancy outcome. You should share all details with your gynaecologists and follow the instructions. Maintain regular contact with your gynaecologist is a must. The hospital which you choose for delivery should be adequately equipped with a very good nursey back up .

SIGNS AND SYMPTOMS THAT YOU MUST NOT IGNORE

If you have a high-risk pregnancy and you develop any of the following signs and symptoms, you should visit a gynecologist with expertise in high-risk pregnancy cases.

• You fall unconscious., in this case, you would not be able to take any step. Therefore, you need to inform your partner or friend, beforehand, what to do, if such a situation arises.
• You experience vaginal bleeding.
• You experience a burning sensation or pain while urinating.
• You experience persistent nausea or vomiting.
• You have signs of dizziness.
• You experience chills or fever.
• You experience intolerable pain in the pelvis or cramping in your lower abdomen.
• Fluid leakage takes place from the vagina
• You have persistent back pain or pelvic pressure.
• You find that your baby’s movements have stopped or are less than normal (less foetal activity).
• You develop symptoms of pre-eclampsia such as an extreme headache, vision issues like blurring or dimness, or a sudden swelling of the face, feet, or hands.
• During pregnancy, you must be essentially careful and look out for any abnormal signs.
• You develop unhealthy thoughts of harming the baby or yourself.

Dr. Madhu Goel
Associate Director
Fortis La Femme, Greater Kailash.