Many conditions affecting a mother or her baby before, during or after pregnancy can designate a pregnancy as high risk. Special monitoring or care throughout pregnancy is needed in such cases and hence understanding and identifying the risk factors is essential.

Risk factors for a high-risk pregnancy

A high-risk pregnancy is the result of a medical condition present before pregnancy or a medical condition that develops during pregnancy for either you or your baby

• Advanced maternal age. Pregnancy risks are higher for mothers older than age 35.
• Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put a pregnancy at risk.
• Medical history. A history of chronic hypertension, diabetes, heart disorders, breathing problems such as asthma,thyroid disorder, infections, and blood-clotting disorders such as deep vein thrombosis can increase pregnancy risks.Chronic kidney diseaseincreases risk of miscarriage, developing high blood pressure and preeclampsia.Lupus and other autoimmune diseases can increase risk of preterm delivery, preeclampsia, and having a small baby.
• Surgical history. A history of multiple C-sections, multiple abdominal surgeries or surgery for uterine tumors (fibroids), can increase pregnancy risks and requiring close labour monitoring.
• Pregnancy complications. Various problems that develop during pregnancy can pose risks like abnormal placenta position orfetal growth restriction. Rh (rhesus) sensitization - a potentially serious condition that can occur when mother`s blood group is Rh negative and baby’s blood group is Rh positive can affect the health of developing baby.
• Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher order multiples.
• Obesity Having a body mass index (BMI) of 30 or higher before pregnancy puts one at greater risk of gestational diabetes, type 2 diabetes, and high blood pressure during pregnancy and increased chances of operative delivery.

Precautions to take to promote a healthy pregnancy

• Schedule a preconception appointment. Consult a doctor before planning pregnancy. It is important to take prenatal vitamins. Optimization of any health conditions is ideal pre-conception and also achieve a desired pre-pregnancy healthy weight.
• Seek regular prenatal care. Prenatal visits can help doctors monitor your and your baby's health. Depending on the circumstances, you might be referred to a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.
• Eat a healthy diet. During pregnancy, you'll need more folic acid, protein, calcium and iron. A daily prenatal vitamin can help fill any gaps
• Gain weight wisely. Gaining the right amount of weight can support your baby's health — and make it easier to shed the extra pounds after delivery.
• Avoid risky substances. Smoking is harmful for the developing fetus,hence quitting is ideal. Alcohol and illegal drugs are also off-limits.

Specialized tests which may be recommended in some high risk pregnancies

• Targeted ultrasound, Biophysical profile & Nonstress test
• Amniocentesis. During this procedure, a sample of the amniotic fluid that surrounds the baby during pregnancy is withdrawn from the uterus to identify certain genetic conditions, as well as abnormalities of the brain or spinal cord.
• Chorionic villus sampling (CVS). During this procedure, a sample of cells is removed from the placenta. Typically done between weeks 10 and 12 of pregnancy for certain genetic conditions
• Cordocentesis. Also known as percutaneous umbilical blood sampling, this is a diagnostic prenatal test in which a sample of the baby's blood is removed from the umbilical cord for testing
• Ultrasound for cervical length. To determine any risk of preterm labor.