Older expecting parents often worry they’ve reached high-risk pregnancy age and fear living through 9 months of stress. But what is a high-risk pregnancy, exactly? The phrase sounds ominous, but high-risk pregnancy is used to describe situations where the life of the mother, or the baby, are statistically more likely to be at risk compared to typical pregnancies. Importantly, these situations don’t have to be extreme or unusual. After all, the feared high-risk pregnancy age (known as advanced maternal age) is only 35. On its own, the pregnancy age risk doesn’t sound so bad, and frankly, it isn’t. But added to other pregnancy risk factors, the danger can add up.
“The risk of hypertension in pregnancy and pre-eclampsia increases with age. Multiple gestations increases these risks too,” says Dr. Daniel Shapiro, a reproductive endocrinologist and fertility specialist at Reproductive Biology Associates. “Obesity in pregnancy – BMI over 30 – is an independent risk factor for many problems in pregnancy including pre-eclampsia.”
So age, multiples, and weight can all lead to complications in pregnancy. These complications can include gestational diabetes, needing a c-section delivery, delivering preterm, or having a low or very-low-birth-weight baby. And these risk factors can stack. A woman of 35, with a BMI of 30, carrying twins may be at greater risk than a woman exhibiting only one of those risk factors. Disease and pre-existing conditions can also complicate a pregnancy; pre-eclampsia occurs in higher rates in women who suffer from chronic kidney disease, vascular diseases like lupus, high blood pressure, or previous occurrences of pre-eclampsia.
While that’s all worrying – and the health of mother and child is something that parents need to take seriously – these risks may cause more anxiety than they warrant. After all, some studies suggest that getting pregnant over 35 has its advantages, and every birth can face some complications.
“That’s just the basic list of scary issues,” says Shapiro. “Even with all the things that can go wrong, the vast majority of women over 35 have completely normal, healthy pregnancies.”
What is a High-Risk Pregnancy?
- The risk factors are not extraordinary: advanced maternal age, weight, and carrying multiples can all contribute to a risky pregnancy, and they are all reasonably common. They are also often outside of people’s control.
- There are way more appointments: high-risk pregnancies require more monitoring, and may even include a specialist like a perinatologist.
- Deal with it together: high-risk pregnancies come with a ton of anxiety. Partners should have open and honest conversations and speak to others who have gone through the same stress.
- Understand signs of emergency: moms are pretty good about watching out for symptoms, but they can’t do it themselves. Dad needs to learn the danger signs and watch for them, too.
- Self-care is important: eating well, sleeping right, and exercising under a doctor’s supervision are all encouraged, as is mental health and stress management.
Expectant mothers will need to stay in contact with their obstetrician, and may also see a specialist, such as a perinatologist, who specializes in managing these risk factors. There will be more doctor appointments than one might expect, but that’s hardly a problem. It just means more opportunities for parents and doctor to learn more information.
“As an MD, I like having patients in my care ask as many questions as possible. I think patients – men and women both – remember what’s important when it comes out in conversation,” says Shapiro. “Bottom line, ANYTHING on a patient’s mind related to how pregnancy should be – about labor, nutrition, safety, sex during pregnancy, environmental exposures, etc. – should be presented to her care-provider.”
Expecting parents shouldn’t be reluctant to ask questions, nor should they be reticent to share other information. Let the obstetrician or perinatologist decide if it is significant. That’s usually not a problem, says Shapiro, but there are certain things parents should look for.
“Pregnant women can usually be counted on to report EVERYTHING to their OB, but it is worth listing the important signs and symptoms of possible – but not definite – problems: bleeding of any kind, abdominal pain or contractions, shortness of breath, chest pain, severe headache, blurry vision, persistent nausea or vomiting, or dizziness. After 20 weeks, women should also report any noticeable decrease in the baby’s movements.”
Otherwise, the best thing an expectant mother can do is take care of herself, under the guidance of her doctor: eating well, staying hydrated, getting sleep, and maintaining good dental hygiene. Most concerns regarding fish and caffeine are overblown, but it really depends on the type of fish and the amount. Parents should also prioritize their mental health, Shapiro recommends.
“Pregnancy can also stir lots of emotions; exhilaration, terror, anxiety, joy, frustration,” he says. “A supportive partner obviously helps smooth this out, but couples should be alert to serious and persistent mood changes as they may portend an increased risk of postpartum depression.”