For many women, the greatest challenges of pregnancy include morning sickness, indigestion and swollen ankles. However, about 6-8 percent of pregnant women have risk factors that may increase the likelihood of complications during pregnancy.
In this video, San Diego Health host Susan Taylor talks with Shahram Daneshmand, MD, medical director of maternal and fetal medicine at Scripps Clinic, and prenatal genetic counselor Sara Fernandes about high-risk pregnancies and how to minimize the risk of complications.
A high-risk pregnancy happens when there are certain conditions, such as high blood pressure or diabetes, that increase the risk of complications to mom and baby. In such cases, maternal and fetal medicine specialists provide additional expertise and care to the medical team to help keep mother and baby healthy.
“We really serve as consultants to obstetricians, midwives and family practitioners,” explains Dr. Daneshmand. “Think of us as radiologists for the baby during pregnancy and as internal medicine physicians for the expectant mother. We help manage high-risk issues and provide care if complications arise.”
Many people know that women who become pregnant at age 35 and older are considered high-risk, but the same is true of very young women. Pregnant women younger than age 17 have an increased risk of having a baby born prematurely.
In addition, pregnant women who have previously delivered prematurely, or are carrying more than one child, have an increased risk of early delivery. More than half of all twins and as many as 93 percent of triplets are born prematurely.
Diabetes is another risk factor. Women who have type 1 or type 2 diabetes may need additional monitoring during pregnancy, and some women develop diabetes during their pregnancy. This condition, called gestational diabetes, may develop when a pregnant women’s body becomes more resistant to insulin. Blood sugar levels increase, which can create complications for both mother and baby. In most cases, gestational diabetes ends after the baby is born.
“The Scripps Whittier Diabetes Institute offers diabetes services for pregnant women who already have diabetes or develop gestational diabetes, and our physicians work closely with them to ensure women are getting the care they need throughout their pregnancy,” says Dr. Daneshmand.
A pregnant woman who has hypertension, meaning her blood pressure is higher than normal, may have an increased risk to both her own health and her baby’s.
“Women with hypertension can also have complications such as preeclampsia, as well as risk of stroke or heart attack,” says Dr. Daneshmand. “In addition, the baby’s growth may be restricted or the placenta that supports the fetus may separate from the uterine wall. We take steps to manage those risks and try to prevent complications.”
All women should have prenatal visits with their physicians to monitor the health of their baby, but women who have high-risk pregnancies often need additional care. Depending on the risk factors, the medical team may do more ultrasound exams or other tests to check the baby’s growth and development.
“If a woman has heart disease or diabetes, or has a family history of heart defects, we may recommend a fetal echocardiogram, which is looking at the heart in detail with ultrasound,” explains Dr. Daneshmand. “Depending on the pre-existing condition, we may do serial growth scans just to make sure that the baby is growing at the appropriate rate.”
If you’re planning to become pregnant, Scripps physicians recommend making an appointment with your health care provider to discuss any risk factors that may affect your pregnancy, from medications and environmental toxin exposure to medical issues or genetic conditions.
If women have very specific questions about a genetic disease, their physician may recommend meeting with a genetic counselor before becoming pregnant. Scripps genetic counselors are health care professionals who have advanced education and training in medical genetics and counseling. In addition to providing information and guidance about genetic testing, genetic counselors interpret test results and advise families about their options.
“As a prenatal genetic counselor, I educate patients about potential conditions that may affect the baby and the types of screening tests available to help determine the risk,” says Sara Fernandes. “Pregnant women are offered a lot of different testing options, which can feel very overwhelming, so we help them understand all that and make informed decisions.”
At Scripps, caring for a pregnant woman and her child is a team approach. “Scripps offers comprehensive prenatal care, labor and delivery services, including specialty care when needed,” says Dr. Daneshmand. “We all work very closely together to help make the pregnancy as healthy and risk-free as possible.”