What is an at-risk pregnancy?

Although pregnancy goes smoothly for most women, some pregnancies are considered ‘at risk.’ An at-risk pregnancy happens when any serious medical, social and/or psychological problem puts a pregnant woman’s health, or the health of her developing fetus or newborn, in jeopardy. The problem that puts a pregnancy at risk may have been there before the pregnancy. It may also develop during pregnancy, labour and birth, or right after the birth. Here are some reasons why a pregnancy may be considered ‘at risk’: The mother has heart disease or diabetes. The mother suffers from drug addiction. The mother goes into premature labour. The mother is not receiving adequate care during her pregnancy. The mother is carrying multiple babies: twins, triplets or more. The mother is older than 35 and pregnant for the first time.

How do doctors decide that a pregnancy is high risk?

At your first prenatal visit, your doctor will determine whether your pregnancy is at risk by considering the following:
• Your present state of health.
• Your family history.
•Your obstetrical and gynaecological history.
• The results of your physical examination and routine laboratory tests. Your doctor will consider your risk level at each visit during your pregnancy.

Special Care for Higher Risk

Most pregnancies fall into a low-risk category. About 20 percent of pregnancies fall into the high-risk category, and only three percent of high-risk pregnancies are considered ‘very high risk,’ which means the mothers must be cared for and the babies born at a specialized perinatal centre. Perinatal centres are hospitals that manage uncomplicated pregnancies, but also provide the advanced care and treatment for high-risk pregnancies. They are located in major cities in most provinces. If you do not live in a major urban centre with a perinatal centre, you may have to be transferred out of your community if your pregnancy becomes high-risk. There are often accommodations close by where family members can stay at a reasonable cost. Also, these hospitals usually offer prenatal and breastfeeding classes, as well as other programs.

A woman whose pregnancy is high-risk is usually cared for by an obstetrician, after being referred to one by her family doctor or midwife. Sometimes the family doctor or midwife continues providing prenatal care while closely monitoring the progress of the pregnancy with a consulting obstetrician. One visit to the obstetrician is all that is necessary for some women.

High-risk newborns

Some babies need specialized care at birth and for some time afterwards. This advanced monitoring and treatment usually takes place within the perinatal centre, in a newborn intensive care nursery (NICU). ‘Neonate’ is the term for a newborn. A neonate is cared for by a ‘neonatologist’ —a doctor that cares especially for high-risk or sick newborns. Paediatricians also care for these babies. Mothers of high-risk newborns who give birth at a perinatal centre can be near their babies. Some babies born outside these centres become high-risk at birth, and must be transferred to a specialized treatment centre. Every effort is made to let parents stay with their baby and take part their baby’s care as much as possible.

Once at risk, always at risk?

A healthy woman and baby can become at risk during labour, childbirth or after birth. This is one of the reasons why a pregnant woman has a physical examination when she is admitted to hospital, has blood and urine samples taken and has a monitor applied to her abdomen to check the baby’s heartbeat. Not all high-risk pregnancies remain high-risk.

The pregnancy may become low-risk:

• With medical treatment (such as stopping premature labour).
• By nature ‘taking its course’ (such as a baby in the breech position turning to a head-first position on its own).
• When positive lifestyle changes are made by the mother (such as stopping smoking or alcohol and drug abuse).
• Canadian women are lucky to have a health care system that can provide the expertise and technology needed to identify and to treat high-risk pregnancies.

Sharon Staseson, RN, MSN, is a Women’s and Children’s Health Consultant, Sharon Staseson and Associates, Regina, SK. Originally published in April 2008.