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From th e US Department of Health and Human Services , National Institutes of Health

https://www.nichd.nih.gov/health/topics/high -risk/conditioninfo/factors

The more risk factors a woman has, the more likely sh e and her fetus will be at risk during pregnancy

and birth. Statistics are available for some risk factors:

• High blood pressure. According to statistics collected by the National Heart, Lung, and Blood

Institute , about 6% to 8% of pregnant women in the United States have high blood pressure.

About 70% of them are women who are pregnant for the first time.

• Preeclampsia. Preeclampsia affects an estimated 3% to 5% of pregnancies in the United States,

and 5% to 10% of all pregnancies globally. The majority occur at ter m.

• Multiple births (twins). The National Center for Health Statistics reported that between 1980

and 2009, the twin birth rate increased 76% —from 19 to 33 per thousand births. For women

between the ages of 35 and 39, twin births rose by 100%, and for women aged 40 and older, the

increase in twin births was more than 200%. The increase in multiple births is due in part to the

use of fertility treatments, especially in women older than age 35.

• Gestational diabetes. According to the Centers for Disease Control and Prevention (CDC),

gestational diabetes affects 2% to 10% of pre gnancies.

• Women over the age of 40 . The CDC also reported that the birth rate for women in their early

40s increased to 10.2 births per 1,000 women in 2010, the highest rate since 1967. This increase

is attributable at least in part to the expanded use of assisted reproduction technology (fertility

treatments).

What are the factors that put a pregnancy at risk?

The factors that place a pregnancy at risk can be divided into four categories:

Existing Health Conditions

• High blood pressure. Even though high blood pressure can be risky for mother and fetus, many

women with high blood pressure have healthy pregnancies and healthy children. Uncontrolled

high blood pressure, however, can lead to damage to the mother's kidneys and increases the

risk for low birth weight or preeclampsia .

• Polycystic ovary syndrome. Polycystic (pronounced pah -lee -SIS -tik ) ovary syndrome (PCOS) is a

disorder that can interfere with a woman's ability to get and stay pregnant. PCOS may result in

higher rates of miscarriage (the spontaneous loss of the fetus before 20 weeks of pregnancy),

gestational diabetes, preeclampsia, and premature delivery.

• Diabetes. It is important for women with diabetes to manage their blood sugar levels before

getting pregnant. High blood sugar levels can cause birth defects during the first few weeks of

pregnancy, often before women even know they are pregnant. Controlling blood sugar levels

and taking a multivitamin with 40 micrograms of folic acid every day can help reduce this risk.

• Kidney disease. Women with kidney disease often have difficulty getting pregnant, and any

pregnancy is at significant risk for miscarriage. Pregnant women wi th kidney disease require

additional treatments, changes in diet and medication, and frequent visits to their health care

provider. What is a high -risk pregnancy?

From th e US Department of Health and Human Services , National Institutes of Health

https://www.nichd.nih.gov/health/topics/high -risk/conditioninfo/factors

• Autoimmune disea se. Autoimmune diseases include conditions such as lupus and multiple

sclerosis. Some autoimmune diseases can increase a women's risk for problems during

pregnancy. For example, lupus can increase the risk for preterm birth and stillbirth. Some

women may f ind that their symptoms improve during pregnancy, while others experience flare

ups and other challenges. Certain medications to treat autoimmune diseases may be harmful to

the fetus as well.

• Thyroid disease. Uncontrolled thyroid disease, such as an overactive or underactive thyroid

(small gland in the neck that makes hormones that regulate the heart rate and blood pressure)

can cause problems for the fetus, such as heart failure, poor weight gain, and birth defects.

• Infertility. Several studies have found that women who take drugs that increase the chances of

pregnancy are significantly more likely to have pregnancy complications than those who get

pregnant without assistance. These complications often involve the placenta (the organ linking

the fetus and the mother) and vaginal bleeding.

• Obesity. Obesity can make a pregnancy more difficult, increasing a woman's chance of

developing diabetes during pregnancy, which can contribute to difficult births. On the other

hand, some women weigh too little for their own health and the health of their growing fetus. In

2009, the Institute of Medicine updated its recommendations on how much weight to gain

during pregnancy. New recommendations issued by the American College of Obstetricians and

Gynecologists suggest that overweight and obese women may be able to gain even less than

what is recommended and still h ave a healthy infant.

• HIV/AIDS. HIV/AIDS damages cells of the immun e system, making it difficult to fight infections

and certain cancers. Women can pass the virus to their fetus during pregnancy; transmission

also can occur during labor and giving birth or through breastfeeding. Fortunately, effective

treatments exist to reduce the spread of HIV from the mother to her fetus, newborn, or infant.

Women with very low viral loads may be able to have a vaginal delivery with a low risk of

transmission. An option for pregnant women with higher viral loads (measurement of the

amou nt of active HIV in the blood) is a cesarean delivery , which reduces the risk of passing HIV

to the infant during labor and delivery. Early and regular pren atal care is important. Women

who take medication to treat their HIV and have a cesarean delivery can reduce the risk of

transmission to 2%.

Age

• Teen pregnancy. Pregnant teens are more likely to develop high blood pressure and anemia

(lack of healthy red blood cells), and go into labor earlier than women who are older. Teens also

may be exposed to a sexually transmitted disease or infection that cou ld affect their preg nancy.

Teens may be less likely to get prenatal care or to make ongoing appointments with health care

providers during the preg nancy to evaluate risks, ensure they are staying healthy, and

understand what medications and drugs they can use.

• First -time pregnancy after age 3 5. Older first -time mothers may have normal pregnancies, but

research indicates that these women are at increased risk of having : What is a high -risk pregnancy?

From th e US Department of Health and Human Services , National Institutes of Health

https://www.nichd.nih.gov/health/topics/high -risk/conditioninfo/factors

o A cesarean delivery (when the newborn is delivered through a surgical incision in the

mother's abdomen)

o Delivery complications, including excessive bleeding during labor

o Prolonged labor (lasting more than 20 hours)

o Labor that does not advance

o An infant with a genetic disorder, such as Down syndrome.

Lifestyle Factors

• Alcohol use. Alcohol consumed during pregnancy passes directly to the fetus through the

umbilical cord. The Centers for Disease Control and Prevention recommend that women avoid

alcoholic beverages during pregnancy or when they are trying to get pregnant. During

pregnancy, women who drink are more likely to have a miscarriag e or stillbirth. Other risks to

the fetus include a higher chance of having birth defects and fetal alcohol spectrum disorder

(FASD). FASD is the technical name for the group of fetal disorders that have been associated

with drinking alcohol during pregnan cy. It causes abnormal facial features, short stature and low

body weight, hyperactivity disorder, intellectual disabilities , and vision or hearing problems.

• Cigarette smoking. Smoking during pregnancy puts the fetus at risk for preterm birth, certain

birth defects , and sudden infant death syndrome (SIDS) . Secondhand smoke also puts a woman

and her developing fetus at increased risk for health problems.

Conditions of Pregnancy

• Multiple gestation. Pregnancy with twins, triplets, or more, referred to as a multiple gestation,

increases the risk of i nfants being born prematurely (before 37 weeks of pregnancy). Having

infants after age 30 and taking fertility drugs both have been associated with multiple births.

Having three or more infants increases the chance that a woman will need to have the infant s

delivered by cesarean section. Twins and triplets are more likely to be smaller for their size than

infants of singleton births. If infants of multiple gestation are born prematurely, they are more

likely to have difficulty breathing.

• Gestational diabetes. Gestational diabetes, also known as gestational diabetes me llitus, GDM,

or diabetes during pregnancy, is diabetes that first develops when a woman is pregnant. Many

women can have healthy pregnancies if they manage their diabetes, following a diet and

treatment plan from their health care provider. Uncontrolled ge stational diabetes increases the

risk for preterm labor and delivery, preeclampsia, and high blood pressure.

• Preeclampsia and eclampsia. Preeclampsia is a syndrome marked by a sudden increase in the

blood pressure of a pregnant woman after the 20th week of pregnancy. It can affect the

mother's kidneys, liver, and brain. When left untreated, the condition can be fatal for the

mother and/or t he fetus and result in long -term health problems. Eclampsia is a more severe

form of preeclampsia, marked by seizures and coma in the mother.