Common Questions About High-Risk Pregnancy

What is a High-Risk Pregnancy?

A high-risk pregnancy is one in which a wide variety of maternal or fetal conditions may be occurring. Many high-risk pregnancies are related to pre-existing maternal health conditions or conditions that may have developed during pregnancy. In other instances, a high-risk pregnancy can be due to fetal birth defects or complications. 

If you have been diagnosed with a high-risk pregnancy due to a fetal birth defect or complication, you may feel overwhelmed or anxious. These pregnancies often involve more testing, doctor’s appointments, and interventions — all of which can cause concern about your well-being and the well-being of your baby.

Fortunately, maternal-fetal medicine specialists today are well versed in supporting women throughout their high-risk pregnancies. At The Chicago Institute for Fetal Health, maternal-fetal medicine specialists work in a multidisciplinary approach with pediatric specialists, including fetal surgeons and neonatologists. The goal is to empower families. We can help you understand your baby’s diagnosis, prepare for birth, learn what to expect after birth and provide follow-up care for all babies, regardless of where they are born.

What is a Maternal-Fetal Medicine Specialist?

A maternal-fetal medicine (MFM) specialist is an obstetrician-gynecologist (OB/GYN) who has received specialized training to care for patients who are at a high risk of having a complicated pregnancy. The additional 2-3 years of training provides them with expertise in diagnosing and managing high-risk pregnancies as well as in the assessment and care of fetal complications. Most fetal ultrasounds are interpreted by maternal-fetal medicine specialists.

Typically, a OB/GYN will provide a referral to a maternal-fetal medicine specialist, if necessary. The MFM then partners with multiple caregivers, including your OB/GYN, to consult, manage and care for the complication that has been diagnosed. This can occur before, during and after pregnancy. If a birth defect or fetal complication is found during pregnancy, MFM specialists have the expertise to monitor and treat the baby until they are ready to be born.

What fetal complications may lead to a high-risk pregnancy?

It is possible for complications in the fetus to develop during pregnancy. Pregnancy at a young age (<19) or with an advanced maternal age (>35) may contribute to an increased risk for certain birth defects. Also, if you have had complications or high-risk pregnancies in the past, you might be more susceptible to another one. Various fetal complications can make a pregnancy high-risk, including:

• Birth defects – A birth defect is a condition that develops during the pregnancy and remains at birth. It affects 2-3 percent of all babies born in the US. With advancements in prenatal diagnosis and treatment, it is now possible to detect, and often, treat some birth defects before birth. Some common birth defects include congenital diaphragmatic hernia, spina bifida, heart defects, and cleft lip and palate.
• Multiples — Twin pregnancies or pregnancies with higher-order multiples, have a higher risk of fetal anomalies and growth problems. Some of these conditions include twin-to-twin transfusion syndrome and selective intrauterine growth restriction. If you have a multiple pregnancy, a MFM specialist will closely monitor the pregnancy by performing additional ultrasounds.
• Genetic conditions — There are thousands of different genetic disorders that vary in severity. The specific genetic condition depends on what is seen on the ultrasound or in advanced genetic testing. A genetic counselor can help you understand these conditions and how they might affect your baby and your family.

How does being high-risk affect pregnancy care?

Having a high-risk pregnancy often means going to more prenatal appointments and getting extra provider attention. Your individual diagnosis will determine the exact care you and your baby receive. If you have been diagnosed with a high-risk pregnancy due to a fetal complication, you may be referred to a fetal center with experts who are specially trained for these cases.

You may require other diagnostic exams to make sure your baby is developing well. These can include:

• Specialized or targeted ultrasound: Your maternal-fetal care team might order targeted ultrasounds to monitor specific aspects of your baby’s anatomy and growth. These ultrasounds can be used to monitor placental position as well.
• Fetal echocardiogram: A fetal echocardiogram will give a fetal cardiologist a clear picture of your baby’s developing heart. It is very important to diagnose heart issues before birth to ensure that your baby is getting the treatment best suited for his/her diagnosis.
• Amniocentesis: In this procedure, a sample of amniotic fluid is taken for testing. If there is any concern about a genetic birth defect or neural tube defect, your doctor may recommend an amniocentesis.
• Open fetal surgery: In some cases, such as spina bifida, multiple gestations, or congenital diaphragmatic hernia, in utero procedures can ensure the best possible outcome once your baby is born.

These tests and procedures can feel overwhelming or frightening. It’s important to remember that they all serve the purpose of supporting you and your baby to ensure the best outcome possible.

What's the next step after a high-risk pregnancy diagnosis?

Being diagnosed by your OB or MFM with a high-risk pregnancy due to a fetal birth defect or complication is overwhelming. It is important to be prepared for the next steps in your care. Finding a comprehensive fetal care center that can provide better insight into the severity of the diagnosis and manage care from pregnancy to birth and beyond is critical. The Chicago Institute for Fetal Health is available to help you navigate what to expect moving forward, whether you need additional diagnostic studies, more counseling or specialized care like fetal surgery or complex newborn surgery. Collaboration, communication, and coordination will continue with your providers to ensure that you, and all the key people, are prepared for the delivery and expected care after your baby is born. 

Becoming a parent is an exciting, life-changing event, and it can be confusing and scary when handling medical issues that you or your baby may be experiencing. The Chicago Institute for Fetal Health is here to support you and your family from beginning to end, and beyond.

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