It’s natural to be nervous during pregnancy, even if everything goes as well as possible. If you’ve been told you have a high-risk pregnancy, of course you’re likely to feel anxiety and even fear.
A maternal-fetal medicine specialist can help. Also called perinatologists, these doctors complete specialized training to care for women and their babies during high-risk pregnancies.
“A high-risk pregnancy is any issue that makes the pregnancy too complicated for the mother or fetus to be managed by a general OB-GYN,” says UNC Health maternal-fetal medicine specialist Ebony B. Carter, MD, MPH.
Many issues can make a pregnancy high-risk. Sometimes the concern is the health of the mother, because of a condition such as diabetes, heart disease, cancer or a previous organ transplant. Sometimes the issue is with the fetus—maybe a scan has revealed that an organ is not developing properly or has a defect.
There are also pregnancy-related developments, such as a pregnancy with twins or triplets, preeclampsia or a placental issue, that can make a pregnancy high-risk.
We talked to Dr. Carter to learn more about how a maternal-fetal medicine specialist can support you before, during and after a high-risk pregnancy.
Before Pregnancy: Have a Pre-Pregnancy Visit
If possible, it’s best to see your doctor before you become pregnant, to make sure your body is ready for pregnancy. Your provider will make sure you’re up to date on preventive screenings and vaccinations and recommend lifestyle changes that support healthy pregnancy, such as starting a prenatal vitamin.
If you know you have a preexisting health issue, this visit is especially important.
“There are very few conditions where I’d say that someone is too sick to get pregnant, but it’s an issue of readiness,” Dr. Carter says. “There’s a lot we can do to address risk factors and reduce possible complications.”
For example, if you have type 1 diabetes that’s not well-controlled, there is a greater risk for structural anomalies, or defects in how parts of the body form, for the fetus. Working with a doctor to make sure diabetes is well-controlled before pregnancy brings your risk for those anomalies back down to nearly the general risk level, Dr. Carter says.
Ask your doctor about your medications and whether you need to adjust any of them before or during pregnancy. Abruptly stopping medications when learning you’re pregnant is not always the right course of action, Dr. Carter says. If you see a specialist, such as a cardiologist, check in with them so you have a plan for any risks specific to you and your baby during pregnancy and delivery. If you have a genetic health condition, you can consider genetic testing (which can be done before pregnancy) or learn more about the chances of your child inheriting the disorder.
It’s important to know that simply being pregnant over the age of 35—that’s “advanced maternal age”—does not automatically make you high-risk or require you see a maternal-fetal medicine specialist. Over the age of 40, though, there are increased risks to consider, Dr. Carter says.
During Pregnancy: Monitoring Growth and Planning for Delivery
Once you are pregnant, your maternal-fetal medicine specialist will work with your OB-GYN to watch for potential complications and keep you and your baby healthy. That usually means more appointments and scans than a typical pregnancy, but how often you see the maternal-fetal medicine specialist will vary.
“Not every patient needs us their entire pregnancy,” Dr. Carter says. “If you have epilepsy and your seizures are well-controlled, for example, we may go over a plan for pregnancy with your regular OB-GYN and be here as a resource as needed. Some might see us once a trimester; some see us for all of their care.”
During the second trimester, all pregnant women have an anatomy scan to look at the baby’s growth and take a closer look at how their organs and bones are developing. Sometimes, this appointment is when a typical-risk pregnancy becomes high-risk because a complication or concern is identified.
Sometimes, doctors can address the problem during pregnancy, such as with fetal surgery for spina bifida. In some cases, you’ll need to plan for your baby’s treatment after birth.
You may also have additional ultrasounds in the third trimester to check on the baby’s growth trajectory and follow-up on any findings from earlier ultrasounds.
“With a high-risk pregnancy, one of my considerations is whether a baby is better off inside of mom or in a neonatal intensive care unit (NICU),” Dr. Carter says. “When it’s early in a pregnancy, the answer is almost always staying pregnant due to the risks associated with extreme prematurity. But as it gets later in the pregnancy, and these risks decrease, we may say that for the health of mom and baby, it’s time for this baby to be born.”
Delivery and After Pregnancy: A Team Approach to Care
Sometimes, a high-risk pregnancy can end with a fairly routine delivery with your preferred provider at a hospital close to your home, but it’s also possible that the factors that make your pregnancy high-risk increase the risk for complications during delivery. A maternal-fetal medicine specialist can help to determine what supports you’ll need for delivery and directly afterwards.
“Delivery can be more dangerous with some conditions, so we may have lengthy, multistep plans with detailed scenarios,” Dr. Carter says. “In some cases, we might have a large team to support the needs of the baby and mother in the delivery room.”
You may want to have a mental health professional on your team as well. Postpartum depression and anxiety can affect any new mother, but the stress of a high-risk pregnancy or complicated delivery can exacerbate those emotions.
After pregnancy and delivery, you typically have at least one follow-up visit with a maternal-fetal medicine specialist to ensure that any health complications related to the pregnancy are resolving and to talk about strategies to reduce risk for any future pregnancies. For some women, every pregnancy will be a high-risk pregnancy due to health concerns, but for other women, subsequent pregnancies may proceed more typically.
“It’s not like once you’re high-risk, you’re always high-risk,” Dr. Carter says. “If someone had a fetal anomaly with their first pregnancy, for example, it may not happen again. But it’s normal to have some trauma from the previous experience, so if you need to see a specialist for a little more reassurance and peace of mind, we’re here.”
Questions about your health and pregnancy? Talk to your doctor, or find one near you.