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Pregnancy can be a significant source of happiness and excitement for the parents, but it can also bring in loads of stress, especially if the expectant mom comes across complications that would put her under the high-risk group. This can put a damper on what could have otherwise be an exciting journey, but it should not leave you hopeless.

High-risk pregnancies may potentially cause anxiety and depression in those who are classified as such. This is why you should seek special care to give yourself and your baby the best chances despite the circumstances.  Some women may feel alarmed when they are given this label, but this is only a way for doctors to indicate that you need to pay close attention to certain symptoms and conditions during the length of your pregnancy.

What is a high-risk pregnancy

A high-risk pregnancy is defined as “one that threatens the health or life of the mother or her fetus”. This suggests that extra care is needed to ensure a successful pregnancy and delivery.  This is often the case if you suffer from a chronic illness or other conditions that would place you in the high-risk category.

It is possible to begin pregnancy without any hiccups but eventually it may develop conditions that will put you in a high-risk category. These problems may be minor or life-threatening for both mother and baby, therefore extra care and monitoring from your doctor are needed.

Risk factors for high risk pregnancy

The factors that place a pregnancy at risk are divided into four categories. These include:

1. Age
2. Lifestyle Factors
3. Existing Health Conditions
4. Conditions of Pregnancy

Age

Teen pregnancy

Pregnant teens have a higher risk of getting high blood pressure called pregnancy induced hypertension compared to women in their 20s to 30s. Studies have also showed that this group has a higher incidence of anemia, premature rupture of membranes (PROM), and low-birth-weight babies. The earlier a baby is born, the higher the risks for cognitive, vision, respiratory, and digestive concerns on top of a host of problems.

Advanced maternal age

The number of women conceiving at 40 have doubled over the last three decades in Singapore. The risk of complications during pregnancy increase in older women. These include gestational diabetes, heart disease, and hypertension. However, research also claimed that older first-time mothers over 35 may have normal pregnancies, but they also have an increased risk of having:

– Labor that does not advance
– Delivery complications (e.g. excessive bleeding during labor)
– Prolonged labor (one that lasts more than 20 hours)
– A cesarean delivery (C-section)

Lifestyle Factors

Alcohol use

Alcohol that is consumed during pregnancy passes directly to the fetus through the umbilical cord. Maternal alcohol ingestion in pregnancy may have harmful effects on the central nervous system and other organs of the developing fetus, depending on the dose, duration and developmental stage of the embryo at exposure. The Centers for Disease Control and Prevention recommended that pregnant women avoid any alcoholic beverage during pregnancy, or even if you are trying to get pregnant. Excessive alcohol consumption at this sensitive time can lead to birth defects, developmental delays, and/or a variety of behavioral changes.

Women who drink during pregnancy are more likely to have a miscarriage or stillbirth. Birth defects and fetal alcohol syndrome disorder (FASD) are associated with heavy alcohol intake and manifest in abnormal facial features, low body weight, short stature, and visual or hearing problems.

Cigarette Smoking

Smoking and secondhand smoke in pregnancies pose health risks and complications to both mom and baby. Women who smoke during pregnancy are more likely than other expectant moms to have a miscarriage. It can also cause problems with the placenta, which is the baby’s source of food and oxygen in utero. It can also put the fetus at risk for preterm birth, certain birth defects (cleft lip, clef palate, or both) and SIDS (sudden infant death syndrome).

Health Conditions

Pre-existing diabetes or Gestational diabetes

Pregnancy brings with it a slew of hormonal changes which can make your blood sugar level rise. Pre-pregnancy diabetes or gestational diabetes raises the odds of pregnancy complications. This would place you at a higher risk of having:

– A higher chance of needing a C-section or assisted birth (with vacuum/forceps)
– Pre-term birth
– A miscarriage
– High blood pressure or preeclampsia

According to recent news, 1 in 9 Singaporeans has diabetes, which pose as a concern for expectant moms. Your blood sugar levels will usually return to normal after giving birth. But there is also a risk of developing type 2 diabetes later, or gestational diabetes again in another pregnancy.

High blood sugar levels also affect the baby since they get nutrients from you. What happens is that the baby stores the extra sugar as fat, causing them to grow larger than normal. This will result in complications like:

– Pre-term birth
– Temporary breathing problems
– Injuries during delivery due to their enlarged size (macrosomia)
– Low blood sugar and electrolyte levels upon birth
– Jaundice (a condition which causes the skin to have a yellowish color)

High Blood Pressure

High blood pressure, or hypertension, is a serious concern for some pregnant women. It is not always dangerous, but uncontrolled blood pressure can cause severe health complications for you and your developing baby. New onset high blood pressure in pregnancy with kidney involvement is called pre-eclampsia and this can even lead to eclamptic fits. The various risks that high blood pressure pose on pregnancy include:

– Decreased blood flow to the placenta
– Placental abruption (a condition where the placenta separates from the inner wall of your uterus before delivery which can cause heavy bleeding in severe cases)
– Intrauterine growth restriction
– Premature delivery
– Injury to your organs
– Future cardiovascular disease

Obesity

Obese women are at increased risk of miscarriage, gestational diabetes, preeclampsia, induced labor, caesarean section, anesthetic complications and wound infections. Babies who are born of obese mothers are at an increased risk of macrosomia, congenital anomalies, prematurity, and stillbirth.

Polycystic ovary syndrome (PCOS)

PCOS is a common endocrine disorder which affects 5-15% of women in the reproductive age. This is linked with irregular menstrual cycle and infertility. Women with PCOS have a higher risk for certain problems or complications during pregnancy which comes with the following complications:

– Miscarriage or early loss of pregnancy
– Preterm birth
– Gestational diabetes
– Pregnancy-induced high blood pressure
– Preeclampsia
– Cesarean delivery

Thyroid Disease

The thyroid hormone plays a critical role during pregnancy both in maintaining the health of the mother and the development of the baby. Common thyroid problems come in two forms, hyperthyroidism and hypothyroidism.

Uncontrolled hyperthyroidism during pregnancy can lead to congestive heart failure (CHF), miscarriage, preeclampsia, thyroid storm, low birth weight and premature birth. Uncontrolled hypothyroidism, especially during the first trimester, is crucial to the development of the fetal brain and nervous system.

What can you do to reduce the risk of pregnancy complications?

To improve your chances despite the risks of pregnancy complications here are some tips that an expectant mom can follow.

Tip 1 Pre-Baby

When you are trying for a baby, you may schedule a preconception visit to ensure that any existing medical issue like heart conditions, hypertension, or diabetes are managed properly. Your doctor will advise you on your medication intake and other related concerns that could potentially affect you and the baby. This will also give you time to make any changes that your care provider recommends before you become pregnant. It is also important that you find out all that you can about your condition and what you can do to stay healthy. Doing your homework also helps you prepare the right questions during your consultation.

Tip 2 Antenatal

As soon as your pregnancy test shows that you are pregnant, the next step is to get a doctor’s appointment. This step makes sure that you undergo the necessary tests for gestational diabetes, down syndrome, etc.

At your first prenatal visit, inform your doctor of any current health problems you have, medications that you are taking, and any difficulties in previous pregnancies. This is also a time where you should discuss diet-control so that any condition or factor that puts you in a high-risk category, is taken into consideration in meal planning.

Tip 3 The Final Stretch

When you are already strutting in your final trimester, an important discussion with your doctor would be labor and delivery arrangements. This may include induction of labor and any other repercussions to avoid potential complications.

Tip 4 Support

Having that status looming above you in this journey, it is important that you ask your partner, family and friends for support. While you make an effort to keep yourself healthy, it is also important that you have a good emotional cushion behind you in this stressful time.

How will you be taken care of in high-risk pregnancy

In a high-risk consultation done early in the first trimester, the obstetrician will discuss the advantages and disadvantages of a normal birth, an instrumental or Caesarean delivery. Expectant mothers with bad obstetric histories may feel extremely anxious, but an early discussion can help alleviate these fears and prepare the couple psychologically on what to expect during delivery.

At the time of the delivery a neonatologist can be present to provide appropriate resuscitation measures. The neonate may require intensive care or emergency management due to a birth defect or difficulty in adaptation to extrauterine life.

Mothers will be closely monitored for any complications that may arise. For instance, mothers with fluctuating blood sugar levels due to uncontrolled diabetes will be closely monitored for hypoglycemia.

The proper management of high-risk pregnancies involve different relevant disciplines coming together for a plan of action. Healthcare in Singapore allows OB-GYNs to work in an ecosystem where members of different medical specialties can co-manage a certain high-risk patient. With the coordinated, holistic care of the high-risk mother and baby, a favorable outcome can be achieved for both.

Wherever you are in your journey to motherhood, and if you have concerns about pregnancy, you may discuss these with Dr. Pamela Tan, a female obstetrician and gynaecologist in Singapore with experience in high-risk pregnancies. Book your consultation today and walk safely on this journey, from screening to delivery.