Pregnancy and childbirth are natural, but… sometimes nature is not always beautiful. There can be dangers to both the mother and the fetus. When a mother comes for prenatal care or consults before pregnancy, it is so that the doctor can assess the risks or complications that may occur, in order to provide the best care for both the mother and the fetus.
What is a high-risk pregnancy?
Normally, a pregnancy is considered “high risk” only when there are “risk factors or complications that may affect the mother and/or the fetus.” The attending doctor will look for and monitor any potential risks. The mother can help the doctor by providing the most detailed medical history possible and informing the doctor if she feels any abnormal symptoms.
What are the risk factors?
- Mother’s age
- Diseases and abnormalities of the mother that occur “before” pregnancy
- Diseases and abnormalities of the mother that occur “during” pregnancy
- Problems related to pregnancy
- Mother’s age
Mother’s age is the most common risk factor. Most mothers understand that older age means higher risk, and that older age increases the chance of a high-risk pregnancy, which is correct. However, very young age can also be a risk.
Mothers who are “under 17 years old” or “over 35 years old” are considered at risk. Young mothers have risks such as preterm labor, small babies, high blood pressure during pregnancy or preeclampsia, postpartum depression, etc. Older mothers face greater risks such as miscarriage, gestational diabetes, preeclampsia, genetic abnormalities of the placenta such as Down syndrome, and more.
- Diseases and abnormalities of the mother that occur “before” pregnancy
All pre-existing diseases of the mother affect pregnancy, including high blood pressure, diabetes, asthma, liver disease, kidney disease, heart disease, etc., as well as infectious diseases, especially sexually transmitted infections such as AIDS, herpes, gonorrhea, etc.
“Risks can occur both ways” — pre-existing diseases may worsen pregnancy complications, or pregnancy may worsen or make it difficult to control existing diseases. If the mother has pre-existing conditions, she should consult both her regular doctor and an obstetrician to assess whether she is ready for pregnancy, how to monitor if she becomes pregnant, what impacts may occur, and if the doctor advises against pregnancy, contraception should be used appropriately according to the existing condition.
Pregnancy when the mother’s health is not ready is dangerous not only to the mother but also to the fetus, and sometimes difficult decisions must be made, such as terminating the pregnancy to save the mother’s life, because continuing the pregnancy could be life-threatening.
- Diseases and abnormalities of the mother that occur “during” pregnancy
This risk is often overlooked because mothers without pre-existing diseases or those in good health often think they will not have problems during pregnancy. This is mostly true, but not for everyone.
The two most common diseases during pregnancy are “diabetes” and “preeclampsia”. All mothers will be screened for gestational diabetes. Older mothers have a higher risk of both diabetes and preeclampsia. Most diseases or abnormalities that occur during pregnancy resolve after delivery, but a small number may persist and become chronic conditions for the mother. Doctors will monitor whether these conditions resolve after birth.
- Problems related to pregnancy
Some pregnancy-related problems may seem harmless or even good news for parents, such as multiple pregnancies, or may not affect the mother’s health as long as she has no abnormal symptoms, such as placenta previa, or the problem may mainly affect the fetus without the mother feeling any abnormality, such as preterm labor, placental abruption, low amniotic fluid, or fetal abnormalities.
- Multiple pregnancies carry higher risks, especially preterm birth. Babies are often small, require long stays in incubators, and have many complications. Additionally, there is a higher incidence of diabetes, preeclampsia, postpartum hemorrhage, etc.
- Placenta previa occurs when the placenta attaches near or covers the cervix (the birth canal), which cannot change position. Most mothers have no symptoms, but if the uterus contracts before or at term, bleeding can occur and be life-threatening.
- Preterm birth is delivery before 37 weeks of gestation. The earlier the birth, the higher the risk of complications for the baby. Some mothers have hidden causes that doctors can treat or prevent to reduce adverse outcomes.
- Placental insufficiency occurs when the placenta deteriorates before term, often in mothers with diabetes or preeclampsia. If the placenta cannot support the baby’s needs, early delivery may be necessary.
- Low amniotic fluid often occurs with placental insufficiency, reducing the fluid around the baby, limiting movement, and compressing the umbilical cord, which decreases nutrient and oxygen supply and may cause fetal death.
- Fetal abnormalities include genetic disorders such as Down syndrome or physical disabilities. All mothers are advised to have blood tests to screen for Down syndrome risk or amniocentesis if indicated. Detailed ultrasound (Anomaly Scan) also helps assess fetal abnormalities, which occur in about 2-3% of all pregnancies.
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Prevention and treatment of complications
Even if the mother appears healthy without pre-existing conditions, doctors usually recommend that mothers planning pregnancy consult before conception for a thorough health check, including history taking, physical examination, and blood tests, to ensure readiness for a safe pregnancy.
Proper basic self-care (which is easy to do) also helps reduce the risk of complications
- Take folic acid vitamins 4-5 mg per day from before pregnancy until delivery
- Get vaccinations as indicated
- Eat nutritious food and maintain appropriate weight
- Exercise appropriately
- Avoid alcohol and smoking
- Attend medical appointments as scheduled
If a mother finds that she is “high-risk pregnancy or at risk”, she will be cared for by a “Maternal-Fetal Medicine specialist” (MFM), who will manage her throughout pregnancy until delivery. They will collaborate with neonatology specialists who will carefully care for the baby immediately after birth.
In summary, proper preparation before pregnancy and quality prenatal care will help ensure everything goes well according to the goals of both parents and doctors: “A live baby, safe mother and baby.”
Dr. Adisorn Aksornphusitpong
Maternal-Fetal Medicine Specialist
Women’s Health Center, Phyathai 3 Hospital
