Adena Health Focus September 19, 2019

Avoid a Rocky Road

Your guide through a high-risk pregnancy and to a healthy outcome for you and baby

The romantic idea of pregnancy goes a little like this: Get pregnant, bask in the glow of motherhood-to-come for nine months, go into labor and have a baby. Like most romantic ideas, reality is much different.

All pregnancies involve some level of risk, some more than others. A high-risk pregnancy can be diagnosed when any condition is present that threatens the life of the mother or fetus.

The United States has one of the highest rates of pregnancy-related maternal mortality of all industrialized nations, and the rate has doubled over the last two decades, making it the only developed nation in the world whose rate is increasing. The Centers for Disease Control and Prevention reports more than 50,000 women each year endure dangerous or life-threatening conditions during pregnancy.

These numbers don’t include women who are not pregnant but may be at risk of developing a high-risk pregnancy.

Experts agree that better health care can prevent or alleviate many pregnancy related complications.

Determining a High-Risk Pregnancy

A high-risk pregnancy can occur at any point during gestation. You don’t need to be initially diagnosed with a high-risk pregnancy to be at risk of developing one, but pre-existing conditions or engaging in certain behaviors can increase your likelihood of such a diagnosis.

“A pregnancy can be labeled as high-risk due to pre-existing conditions,” explains Molly Shoemaker, Certified Nurse Midwife (CNM) with Adena OB/GYN.

Pre-existing conditions can include high blood pressure, diabetes, obesity, age – teenagers and women 35 years and older are most susceptible – tobacco use or substance abuse, or a history of preterm delivery. A pregnancy can become high risk as it progresses due to variables such as a mother carrying multiple fetuses; having a genetic disorder, gestational diabetes or preeclampsia; or going into pre-term labor.

“Due to the many different variants with high-risk pregnancies, it’s hard to say that one trimester is higher risk than another,” Shoemaker says. “As the pregnancy progresses, the monitoring and treatments for that pregnancy may be adjusted to better fit its needs and outcomes.”

Navigating a High-Risk Pregnancy

Every pregnancy requires a high level of care and attention, but a high-risk pregnancy raises the level of care needed and the necessity for the mother to take the initiative to be involved in her care.

Shoemaker advises women to ask questions, research their condition and meet with all potential caregivers — genetic counselors, dietitians, social workers, psychologists, pediatric specialists and anyone else who will be part of your health care team for your diagnosis. At your first prenatal appointment, openly discuss your plan of care.

“Patients should always be involved and comfortable with their plan of care,” urges Shoemaker.

After the first appointment, the general breakdown of your trimesters looks something like this:

First trimester: Your provider will obtain your history and physical. Prenatal lab work will be collected and you will get an ultrasound. Genetic screening will be offered.

Second trimester: A second ultrasound (anatomy scan) will be performed, and a glucose tolerance test will be administered to screen for gestational diabetes. RhoGAM will be given to Rh-negative patients and the Tdap vaccine will be offered.

Third trimester: You will become monitored more closely and see your provider every two weeks until 36 weeks of gestation, when you will be seen weekly.

At any time during this period, if your pregnancy is diagnosed as high risk, you may see the provider more frequently to monitor your and your baby's health and development.

Shoemaker emphasizes that not all variables can be controlled. However, if you are diagnosed with a high-risk pregnancy or potential for a high-risk pregnancy, there are actions you can take to help yourself. Preconception care helps to promote the healthiest pregnancy outcome possible.

For more information or to schedule an appointment, call Adena Women's Health OB/GYN at 740-779-7201 (Chillicothe Campus) or 740-642-4400 (Blackwater Road).