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A high-risk pregnancy is one where the mother or foetus faces an increased risk of complications. This risk can be influenced by a variety of factors, including age, health conditions, and lifestyle choices. In Australia, women who are pregnant at an advanced maternal age (35 years or older) are often considered high-risk due to the increased likelihood of developing conditions such as high blood pressure, diabetes, or pre-eclampsia. These conditions may require additional medical input, ultrasounds, and blood tests to ensure the health of both mother and baby.
| Characteristics | Values |
|---|---|
| Age | Being over 35 or under 17 |
| Lifestyle | Alcohol consumption, smoking and use of illegal drugs |
| Pre-existing medical conditions | Diabetes, high blood pressure, epilepsy, thyroid disease |
| Pregnancy-induced conditions | Gestational diabetes, hypertension, preeclampsia |
| Pregnancy history | Previous miscarriage, preterm labour, caesarean delivery or baby with birth defects |
| Fetus | Twins, fetal growth restriction, chromosome abnormalities |
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What You'll Learn
Advanced maternal age (35+)
Pregnancy at an advanced maternal age, defined as age 35 years or older, is typically considered a 'high-risk' pregnancy. This classification is influenced by a range of social, economic, and cultural factors. The number of people delaying childbirth until after the age of 35 has increased significantly in recent years, with around 20% of total births and 10% of first births in high-income countries occurring in this age group.
Pregnancy at an advanced maternal age is associated with an increased risk of specific complications and adverse outcomes for both the mother and the baby. These risks include:
- Higher chances of delivering multiples, such as twins or triplets, which is considered a risk factor.
- Increased risk of developing gestational diabetes, pregnancy-induced hypertension, and preeclampsia.
- Higher risk of genetic conditions, although the evidence on this topic is limited and conflicting.
- Greater possibility of difficulties in conceiving, which can be influenced by age-related fertility decline.
To promote a healthy pregnancy and positive outcomes at an advanced maternal age, the following considerations are essential:
- Maintaining good health before and during pregnancy can help reduce complications. This includes a well-balanced diet rich in folic acid, abstaining from alcohol and smoking, and regular antenatal care.
- Pre-pregnancy consultations with a healthcare professional can provide personalised recommendations and optimise underlying medical conditions.
- Extra ultrasounds, scans, and blood tests may be recommended to monitor the growth and wellbeing of the baby and identify potential complications early on.
- Collaborative care models involving obstetricians and newborn intensive care units can provide specialised attention and ensure the best care for both mother and baby.
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Pre-existing medical conditions
A high-risk pregnancy is one where the mother or foetus is at a higher risk of complications. This can be due to pre-existing health conditions or new challenges that arise during the pregnancy. Pregnancy at an advanced maternal age (over 35 years old) is usually considered a high-risk pregnancy. Women who get pregnant later in life have a higher chance of delivering multiples, which is often considered a risk. They are also at a greater risk of developing diabetes, high blood pressure, miscarriage, stillbirth, premature birth, and having a baby with chromosomal abnormalities.
Other pre-existing medical conditions that can cause a high-risk pregnancy include:
- Thyroid disease
- Gestational diabetes
- Anaemia (low oxygen-carrying haemoglobin levels in the blood)
- Epilepsy (neurological disorder)
- Hypertension
- Pre-eclampsia
Pregnancies with these pre-existing conditions require close monitoring and special care to reduce the possibility and severity of complications. This may involve more prenatal ultrasounds, blood tests, and careful monitoring.
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Alcohol, smoking, drug use
Alcohol, smoking, and drug use during pregnancy can cause a pregnancy to be classified as high-risk. The Australian Government Department of Health, Disability and Ageing recommends that women who are pregnant or planning a pregnancy should not drink alcohol. Even a small amount of alcohol can harm a baby's development and may have lifelong effects. The baby's blood alcohol level can be approximately the same as the mother's, and the risk of harm to the fetus increases with the amount and frequency of alcohol consumption. Similarly, the effects of cocaine use during pregnancy have been linked to low birth weight and preterm birth.
The use of illegal drugs during pregnancy, such as cannabis or methamphetamines, may also increase the risk of birth abnormalities in the developing fetus, although the specific teratogenic effects are not yet fully understood due to a lack of medical studies. It is important to note that some medications can also be harmful during pregnancy and interfere with fetal development. However, most medicines are considered safe, and it is always advisable to consult a doctor, midwife, or obstetrician for specific concerns or questions.
Smoking during pregnancy is another factor that can increase the risk of complications. Nicotine is a known toxin that can restrict fetal growth and development and increase the risk of preterm labor and delivery. Smoking can also contribute to placental abruption, where the placenta detaches from the uterine wall, resulting in dangerous bleeding and depriving the baby of oxygen and nutrients. Additionally, carbon monoxide from cigarette smoke can affect the baby's oxygen supply, leading to potential long-term consequences for the child's health.
Pregnant women should seek support to quit or reduce their alcohol, smoking, and drug use. Initiatives like Pregnant Pause can help women and their partners go alcohol-free, and organizations such as The FASD Hub provide information about fetal alcohol spectrum disorders. These resources can assist in managing the risks associated with substance use during pregnancy and improving outcomes for both mother and child.
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High blood pressure
Pregnancy is often referred to as the "ultimate stress test" for the body, as a woman's blood volume increases by 30-50% over the course of her pregnancy. Labour and delivery further increase the toll on the body, causing abrupt changes in blood flow and pressure, making the heart work harder. High blood pressure during pregnancy can reduce the amount of oxygen and nutrients that the baby receives through the placenta, leading to potential complications. Therefore, regular monitoring of blood pressure is crucial during pregnancy.
If a pregnant woman has high blood pressure along with severe headaches, blurred vision, or sudden swelling of the hands, feet, or face, she should seek immediate medical attention. During pregnancy, high blood pressure may be pre-existing or a complication of pregnancy. It is important to note that some medications used to treat high blood pressure may not be safe during pregnancy, as they can reduce blood flow to the placenta and potentially affect the baby.
Women with high-risk pregnancies, including those with high blood pressure, should be under the care of a perinatologist or an obstetrician specialised in high-risk pregnancies. They may refer the woman to a perinatal care centre, where obstetricians and a newborn intensive care unit work together to provide the best care for both mother and baby. Additionally, a pre-pregnancy review with a doctor is recommended to optimise health and minimise risks before conception.
To manage high blood pressure during pregnancy, doctors may advise lifestyle changes or recommend safe medications. Keeping active and engaging in daily physical activities, such as walking or swimming, can help maintain normal blood pressure levels. Maintaining a healthy, balanced diet is also crucial in reducing blood pressure. However, there is insufficient evidence to support the effectiveness of dietary supplements like magnesium, folic acid, or fish oils in preventing high blood pressure.
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Gestational diabetes
A high-risk pregnancy is one that poses a threat to the mother or baby before, during, or after birth. Gestational diabetes is one of the most common factors that can make a pregnancy high-risk. It is a condition in which the mother develops diabetes during pregnancy, typically around the 24th to 28th week.
In Australia, the incidence of gestational diabetes has been increasing. Between 2010 and 2018, the rate rose from 5.2% to 16.1%. This increase has been attributed to factors beyond just revised diagnostic criteria. The Australasian Diabetes in Pregnancy Society (ADIPS) changed the diagnostic process and criteria for gestational diabetes in 2015, adopting universal oral glucose tolerance testing (OGTT). Before 2015, a non-fasting glucose challenge test was recommended, followed by a formal fasting 75g 2-hour OGTT only for women above the threshold. The new criteria lowered the glucose thresholds for diagnosis.
To manage gestational diabetes, pregnant women in Australia may require more medical input, extra scans, and blood tests. Antenatal care is essential to monitor the health of both the mother and the baby and prevent complications. This may include regular ultrasounds in the third trimester to check the baby's growth and wellbeing. Lifestyle changes, such as maintaining a healthy weight, eating a balanced diet, and avoiding alcohol and smoking, can also help reduce the risk of complications.
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Frequently asked questions
A high-risk pregnancy means that the mother, the foetus, or both are at a higher risk of complications during or after the pregnancy. This could be due to pre-existing health conditions or new challenges that arise during the pregnancy.
Factors that can make a pregnancy high-risk include the mother's age (being over 35 or under 17), pre-existing medical conditions such as diabetes, high blood pressure, epilepsy, or lifestyle choices such as smoking and alcohol consumption.
Being considered high-risk during pregnancy means that you and your baby may need to be monitored more closely and receive special care to avoid complications. This could include extra ultrasounds, blood tests, and medical input.
