High-Risk Pregnancy

Oct 27
9 min read

High-risk pregnancy refers to any gestation in which the health of the mother, fetus, or both is threatened by preexisting conditions or pregnancy-related complications. In the United States, roughly 6–8% of pregnancies are formally classified as high risk, though the true number is far higher due to widespread underdiagnosis, inadequate prenatal screening, and systemic medical dismissal. Chronic illnesses such as hypertension, diabetes, autoimmune disease, and thrombophilia, along with hormonal therapy, tobacco use, and delayed childbearing, are driving a steady rise in maternal risk. Early, comprehensive prenatal evaluation and continuous monitoring—particularly for blood pressure, clotting abnormalities, and placental function—remain the most effective tools for preventing avoidable maternal and fetal harm.

Overview

What is a high-risk pregnancy?

A high-risk pregnancy is any pregnancy in which the health or safety of the mother, fetus, or both is at greater-than-average risk. These risks may stem from preexisting medical conditions, pregnancy-related complications, or lifestyle and environmental factors that interfere with the body’s ability to maintain normal vascular, hormonal, or immune balance throughout gestation.

All pregnancies carry some degree of risk, but a high-risk pregnancy signals the need for closer medical supervision before, during, and after delivery. Extra monitoring allows healthcare teams to identify complications early—such as hypertension, gestational diabetes, placental issues, or clotting disorders—when intervention can make the greatest difference.

Importantly, being classified as high-risk does not mean a poor outcome is inevitable. Many people with complex pregnancies deliver healthy babies, especially when risks are recognized and managed early. The term 'high-risk' simply means that care is proactive rather than reactive. It may involve more frequent prenatal visits, advanced imaging, or specialist oversight from maternal-fetal medicine, hematology, or cardiology teams.

Still, the emotional toll of hearing that a pregnancy is high-risk should not be dismissed. Anxiety, guilt, and fear are common reactions. Open communication with providers, access to counseling, and consistent prenatal care are essential in helping expectant parents remain informed and supported throughout pregnancy.

Prevalence

How common are high-risk pregnancies?

Globally, an estimated 15–20% of all pregnancies are classified as high risk, but the true number is significantly higher. In the United States, official reports cite 6–8% of pregnancies—about 250,000 to 300,000 per year—as medically high risk. That figure is a statistical illusion. It reflects only what is coded, reported, and documented within a strained, underfunded healthcare system—not what is actually occurring in hospitals, clinics, and emergency rooms across the country.

The underestimation is not a matter of interpretation. Thousands of women every year experience dangerous symptoms dismissed as “normal,” are turned away from care without adequate testing, or are never formally classified as high risk despite fitting and oftentimes exceeding the criteria. This is the direct result of systemic medical gaslighting, chronic understaffing, and profit-driven constraints that have hollowed out maternal care nationwide. In many states, hospitals have closed obstetric units entirely, leaving large regions without specialists capable of identifying or managing complex pregnancies.

Even in well-resourced areas, documentation bias obscures reality. Electronic health records often fail to capture evolving conditions like venous hypertension, autoimmune flares, or clotting disorders unless a provider manually updates diagnostic codes. The consequence is a national dataset that masks risk, deflects accountability, and downplays the scale of maternal vulnerability.

The rise in hypertension, autoimmune disease, obesity, delayed childbearing, and widespread use of hormonal therapy has compounded an already critical situation. Until the healthcare system confronts its own structural failures and stops dismissing maternal symptoms as exaggeration, the statistics will continue to tell a sanitized version of the truth—while women continue to bear the cost.

Diagnosis and Testing

How are high-risk pregnancies diagnosed and monitored?

A high-risk pregnancy is identified through a combination of prenatal evaluation, medical history review, and ongoing monitoring. In many cases, the designation arises early in pregnancy based on preexisting health conditions, but it can also develop later due to complications such as preeclampsia, gestational diabetes, or fetal growth restriction.

Early and consistent prenatal care is critical. The first prenatal appointment should include a full review of your medical, surgical, and reproductive history, medication use, clotting or autoimmune disorders, and family health background. Even subtle details—such as prior miscarriages, hormone therapy, or unexplained swelling—can reveal elevated risk.

Once a pregnancy is classified as high risk, a tailored monitoring plan begins. This often involves:

Blood and Urine Testing: Evaluates blood sugar, kidney and liver function, hormone levels, and screens for infections or genetic conditions.
Ultrasound Imaging: Tracks fetal growth, placental health, and amniotic fluid volume. Patients with high-risk pregnancies undergo ultrasounds more frequently, often every two to four weeks in the second and third trimesters.
Fetal Surveillance: Includes nonstress testing and biophysical profiles to assess fetal heart rate, movement, and oxygenation.
Blood Pressure and Protein Monitoring: Detects early signs of preeclampsia or placental dysfunction.
Advanced Imaging or Genetic Studies: May be recommended for those with clotting disorders, autoimmune disease, or abnormal fetal findings.

For women with vascular, metabolic, or hematologic disorders—including thrombophilia or autoimmune disease—specialized testing such as Doppler flow studies or hematology consultation is essential to identify circulatory issues before they endanger the pregnancy.

Management and Treatment

What are the most common treatments for high-risk pregnancies?

High-risk pregnancies are identified through a combination of clinical evaluation, detailed health history, and continuous physiologic monitoring. Classification can occur early—based on preexisting conditions such as hypertension, diabetes, autoimmune disease, or thrombophilia—or later, when pregnancy-specific complications like preeclampsia, gestational diabetes, or fetal growth restriction emerge.

Accurate diagnosis begins with a comprehensive prenatal evaluation. At the first visit, providers should conduct a full review of medical, surgical, and reproductive history, prior pregnancy outcomes, medications, family history of vascular or metabolic disorders, and any prior miscarriages or unexplained clotting events. Even mild or seemingly unrelated symptoms—like chronic fatigue, swelling, or shortness of breath—can signal early dysfunction.

Once classified as high risk, a structured monitoring plan is developed to track maternal and fetal health across multiple systems. This plan typically includes:

Blood and Urine Testing: Used to assess kidney and liver function, glucose metabolism, hormone balance, and inflammatory markers. Urinalysis also screens for proteinuria, a key early warning sign of preeclampsia. Specialized blood panels may detect anemia, thrombophilia, or autoimmune antibodies that affect placental circulation.
Ultrasound Imaging: Conducted more frequently—often every two to four weeks after mid-pregnancy—to monitor fetal growth patterns, amniotic fluid levels, and placental structure. Targeted Doppler ultrasound evaluates blood flow through the umbilical cord and uterine arteries to detect placental insufficiency or intrauterine growth restriction (IUGR).
Fetal Surveillance: Nonstress tests (NST) and biophysical profiles (BPP) assess fetal well-being by tracking heart rate variability, oxygenation, and movement. These are especially important in pregnancies complicated by clotting disorders or autoimmune disease, where placental microthrombosis can silently compromise fetal health.
Blood Pressure and Protein Monitoring: Routine tracking for hypertension and proteinuria is critical for early detection of preeclampsia-spectrum disorders, one of the leading causes of maternal mortality. Home monitoring devices may be recommended between visits.
Advanced Imaging and Genetic Testing: For women with recurrent miscarriage, abnormal ultrasounds, or a history of thrombophilia or autoimmune disease, additional tests—such as fetal echocardiography, placental Doppler studies, or chromosomal microarray—may identify structural or genetic abnormalities.

For women with hematologic or vascular disorders such as thrombophilia, lupus, or antiphospholipid syndrome (APS), high-resolution Doppler studies, platelet function assays, and hematology consultations are essential. These detect early blood flow disturbances and coagulation imbalances that can threaten both maternal and fetal survival long before clinical symptoms appear.

Outlook and Prognosis

What is the outlook for those deemed high-risk patients?

With modern surveillance and targeted interventions, the majority of high-risk pregnancies result in healthy outcomes. However, these pregnancies carry a higher likelihood of future maternal health issues, including hypertension, cardiovascular disease, diabetes, and vascular complications. Postpartum follow-up is as important as prenatal monitoring, as many conditions—such as preeclampsia or gestational diabetes—can evolve into chronic disorders.

For the child, outcomes depend on the severity of maternal complications and the timing of delivery. Some infants born from high-risk pregnancies may face temporary challenges such as low birth weight or respiratory distress, while others may have increased risk for metabolic, neurological, or developmental disorders later in life. Continuous pediatric monitoring helps identify and address these issues early.

Prevention

How can I reduce my risk of a high-risk pregnancy?

The most effective prevention begins before conception. Many high-risk pregnancies stem from preexisting conditions, unrecognized risk factors, or modifiable lifestyle habits that can be addressed early. The goal is not perfection, but preparation that gives the body the best chance to meet the physical, hormonal, and circulatory demands of pregnancy.

A full preconception assessment allows healthcare providers to identify vulnerabilities—such as hypertension, thrombophilia, autoimmune disease, or metabolic imbalance—before they become crises. For those already pregnant, early prenatal care is the strongest line of defense against complications.

Key strategies include:

Address underlying medical conditions: Manage chronic illnesses such as diabetes, hypertension, and thyroid disorders before and throughout pregnancy to reduce maternal and fetal strain.
Review all medications: Some drugs, including anticoagulants, antiepileptics, and certain antihypertensives, require dose adjustment or substitution to remain safe in pregnancy.
Maintain a healthy body weight: Excess body mass raises the risk of gestational diabetes, preeclampsia, and delivery complications, while being underweight can impair fetal growth.
Avoid tobacco and nicotine entirely: Smoking is one of the most underestimated drivers of pregnancy complications, including placental insufficiency, preterm birth, and stillbirth. It also compounds clotting risk, especially in individuals with undiagnosed thrombophilia or those using hormonal contraceptives prior to pregnancy. Anyone newly diagnosed with a clotting disorder, or with a family member who has one, should take time to review IWBCA’s Tobacco Risk and Pregnancy Safety Resources.
Eliminate alcohol and recreational drugs: Even small amounts of alcohol can harm fetal brain development. Illicit or unregulated substances carry unpredictable cardiovascular and neurological risks.
Plan pregnancy timing and contraception carefully: For those at increased clotting risk, combined estrogen–progestin birth control and certain progestin-only methods may not be safe. Preconception counseling should include individualized contraceptive planning to prevent accidental exposure to high-risk hormones.
Screen for genetic and infectious conditions: Early identification of inherited thrombophilia, sickle cell disease, or viral infections such as hepatitis or HIV allows for tailored preventive care.
Prioritize routine vaccines: Vaccination against influenza, Tdap, and other indicated pathogens reduces complications tied to respiratory or systemic infections.

Pregnancy prevention, in this context, is not about avoiding conception—it is about building physiological resilience before conception occurs. When women enter pregnancy with stable cardiovascular health, balanced hormones, and controlled inflammation, the likelihood of catastrophic complications drops sharply.

Managing High-Risk Pregnancies

How can I manage the emotional and physical toll of a high-risk pregnancy diagnosis?

A high-risk pregnancy tests endurance. It demands structure, adaptability, and the ability to find calm within uncertainty. The physical requirements are real, but so are the emotional components—especially for those managing chronic illness, recurrent pregnancy loss, or complications that force medical interventions.

The first and most important step is to stay connected to your care team. High-risk obstetrics is built on vigilance and communication. Each appointment, lab, or ultrasound provides critical information about how your body and baby are coping. Missing those check-ins increases the risk of preventable emergencies.

To navigate this experience with stability and agency:

Build a support network: Surround yourself with people who understand the stakes—partners, family, friends, or other women navigating high-risk pregnancies. Emotional isolation magnifies stress, which in turn can affect blood pressure, inflammation, and sleep quality.
Balance vigilance with self-preservation: You cannot control every outcome, but you can control how you care for your body. Prioritize rest, hydration, nutrient-rich meals, and light movement as tolerated.
Manage anxiety as part of your care plan: Persistent fear, panic, or intrusive thoughts deserve clinical attention, not dismissal. Ask your provider about therapy, perinatal mental health resources, or safe medication options.
Create an environment of predictability: Keep medical records organized, track symptoms daily, and establish a system for emergencies—who to call, what hospital to go to, and what to bring. Predictability reduces panic.
Stay informed without spiraling: Read credible medical sources and ask your providers to clarify what applies to you. Avoid online forums that amplify fear without providing evidence
Acknowledge what’s out of your control: High-risk pregnancies often involve procedures, medications, or restrictions that can feel invasive or unfair. Acceptance, though difficult, allows you to conserve energy for what truly matters—your safety and your child’s.

A high-risk pregnancy does not define your strength or predict your outcome. It means your body is under surveillance because it is valuable enough to protect. The process is not easy—but with precision, partnership, and unwavering care, many women carry these pregnancies to healthy, full-term deliveries.

Seeking Care

When should I contact my healthcare provider?

Even in well-managed high-risk pregnancies, rapid changes can occur. Immediate medical attention is warranted for any of the following:

Severe abdominal or pelvic pain, contractions, or pressure before 37 weeks
Vaginal bleeding or sudden fluid leakage
Shortness of breath, chest pain, or rapid heartbeat
Severe or persistent headache, vision changes, or facial swelling
Fever above 100.4°F or chills
Dizziness, fainting, or new weakness on one side of the body
Redness, swelling, or pain in a leg or arm (possible blood clot)
Noticeable reduction in fetal movement

Complications can emerge up to six weeks postpartum, especially in those with hypertensive or clotting disorders. Contact your provider immediately for any unusual bleeding, pain, or swelling after delivery. Timely communication saves lives, both during and after pregnancy.

The IWBCA provides the information and materials on this site for educational and informational purposes only. The content is not a substitute for professional medical evaluation, diagnosis, or treatment. Always consult your physician or another qualified healthcare provider regarding any questions you may have about a medical condition, diagnosis, or course of treatment. Do not disregard, delay, or alter medical advice based on information obtained from this site. If you believe you are experiencing a medical emergency, call 911 or your local emergency services immediately.