High-Risk Pregnancy Care

Risk factors that increase the risk of complications for babies:

• A genetic condition, such as Down syndrome or Cystic Fibrosis, is often identified during genetic testing in pregnancy.
• Fetal conditions identified during ultrasound anatomy scans. This can range from kidney to heart to lung problems. Our team of fetal and baby specialists at SSM Health is here to care for you and your baby's complex needs. We incorporate cutting-edge technology to diagnose, monitor, and treat your baby.

Factors that may put moms at risk include:

• Age: under 17 years of age or older than 35
• Pre-existing condition such as diabetes, hypertension, or obesity
• Taking certain medications
• Use of alcohol, illegal drugs, tobacco or vaping
• Past history of miscarriages or pre-term pregnancies
• An infection (e.g., HIV, hepatitis C, chickenpox, rubella or syphilis)
• An unsafe home environment due to physical, emotional or sexual abuse

Certain conditions can also arise during pregnancy, causing complications that require a higher level of care, inlcuding:

• Pre-eclampsia: High blood pressure often developed during the second or third trimester of pregnancy that may lead to kidney and organ problems. Your provider will monitor your blood pressure, medications, and bloodwork to identify this potential complication throughout your pregnancy. 
• Gestational diabetes: This is usually found during 24 to 28 weeks of pregnancy through a glucose tolerance test(s). The test(s) measure your body's ability to process sugar and identifies how quickly it can be cleared from your bloodstream. Higher levels of glucose found in the blood indicate that the woman has difficulty processing the sugar and starches in food.
• Pre-term labor: Labor that begins before 37 weeks. If you experience any of these signs before the 37th week of pregnancy, call your healthcare provider right away. 
  • Change or increase in vaginal discharge (watery, mucas-like, or bloody) 
  • Pelvic or lower belly pressure
  • Mild belly cramps (with or without diarrhea)
  • Your water breaks in a trickle or a gush
  • Regular or frequent contractions that occur 4 or more times in 1 hour (and may be painless)
• Positioning of baby in the womb
• Having twins or multiples

All of these complications can be monitored and treated through lifestyle changes and medical intervention. 

Conditions related to advanced maternal age are usually caused by an abnormal number of chromosomes, or aneuploidy. This causes conditions such as Down syndrome, trisomy 18 and trisomy 13.

AMA can also influence the likelihood of premature delivery. Premature babies are born before their organs have finished growing and can experience a higher chance of lung, intestinal and development issues like:

• Pulmonary hypoplasia
• Bronchopulmonary dysplasia
• Retinopathy of prematurity
• Necrotizing enterocolitis
• Infections (group B strep and E. coli)
• Failure to thrive
• Apnea and bradycardia
• Central nervous system complications of bleeding or poor perfusion

Advanced maternal age also increases the mother’s risk of complications, such as:

• Hypertension (high blood pressure)
• Preeclampsia
• Gestational diabetes
• Placenta previa and placenta accrete
• Ecclampsia
• Stroke
• Myocardial infarction (heart attack)
• Liver disorders
• End-organ damage

It's important that you be monitored at every stage of your pregnancy if you're over 35, so that your care providers can help you prevent and treat complications that can cause premature delivery or the need for a Cesarean (C-section) delivery.

A specific plan will be tailored to you for prenatal care and delivery. This plan may include close monitoring your weight, blood pressure and glucose levels. You may also be given special diet and exercise requirements to stay healthy during your pregnancy. And specific disorders may require therapies depending on the disease, along with continued evaluation of your baby.

If you have known medical disorders, such as diabetes, hypertension or defined genetic disorders, you may benefit from speaking with your obstetrician or one of our high-risk specialists before even getting pregnant for preconception counseling. Planning before conception can help ensure you and your baby have head-start to a happy, healthy pregnancy.

There is no surefire way to prevent gestational diabetes. However, healthy eating, moderate exercise, and managing your weight can minimize your risk.  If you've had gestational diabetes in a past pregnancy, these healthy choices may help you avoid it in your current pregnancy and reduce your chance of getting type 2 diabetes later in life.

Glucose screenings and blood tests are very important early in pregnancy. Typically, screening for gestational diabetes mellitus occurs between 24 and 28 weeks of pregnancy. However, if you or your health care provider has concerns, you may be screened earlier.

• Half of women with gestational diabetes do not show outward signs of the disease, so testing has become a routine part of pre-natal care.
• Risk factors for this condition include a history of diabetes in the family, obesity, and being diagnosed with gestational diabetes in a previous pregnancy.

Diet, exercise, and medication are the three main treatments options for diabetes. Incorporating lifestyle changes is the best way to ensure you and your baby stay healthy during your pregnancy.

After the placenta is delivered, the pregnancy hormones that caused your gestational diabetes go away and your blood sugar levels should fall back to normal.

• Any medicines you were taking to control your blood sugar will usually be stopped after you give birth.
• A two hour blood glucose test is recommended six to 12 weeks after giving birth to make sure that you do not have diabetes or pre-diabetes.

Did you know women who have had gestational diabetes have an increased chance of developing type 2 diabetes later in life. Following a healthy lifestyle, including exercise and weight management, can help prevent or delay the development of type 2 diabetes.