What Makes You High-Risk in Pregnancy?

When your doctor mentions “high-risk pregnancy,” it can feel overwhelming. But understanding what this actually means can help you feel more prepared and empowered to advocate for the care you and your baby need.

A high-risk pregnancy simply means there’s an increased chance of complications that could affect your health, your baby’s health, or both. This doesn’t mean something will definitely go wrong. It means your medical team will watch more closely and may adjust your care plan to catch and address potential issues early.

The designation comes from evidence-based guidelines developed by organizations like the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the American College of Obstetricians and Gynecologists (ACOG). These groups have identified specific factors that statistically increase the likelihood of pregnancy complications.

How Your Age Affects Pregnancy Risk

Age is one of the most common factors that can make a pregnancy higher risk, and it works on both ends of the spectrum.

If you’re under 20, your body may still be developing, which can increase the chances of preterm birth and other complications. Younger mothers also sometimes face challenges accessing consistent prenatal care or may have less experience advocating for their health needs.

Pregnancies after age 35 come with their own considerations. The risk of chromosomal abnormalities like Down syndrome increases with maternal age. There’s also a higher likelihood of developing conditions like gestational diabetes or high blood pressure during pregnancy. Your doctor will likely recommend additional screening tests and more frequent monitoring if you’re in this age group.

This doesn’t mean you can’t have a healthy pregnancy outside the “ideal” age range. Millions of people do. It just means your medical team will be more vigilant.

Medical Conditions You Had Before Getting Pregnant

Pre-existing health conditions are a major factor in determining pregnancy risk. If you were diagnosed with certain conditions before you conceived, they can affect how your body handles pregnancy and how your baby develops.

Conditions that make pregnancy higher risk include:

• Diabetes (type 1 or type 2)
• High blood pressure (hypertension)
• Thyroid disorders like hypothyroidism or hyperthyroidism
• Epilepsy or seizure disorders
• Heart disease or heart valve problems
• Kidney disease
• Lung conditions like asthma or chronic obstructive pulmonary disease
• Autoimmune disorders such as lupus or rheumatoid arthritis
• Blood clotting disorders or a history of blood clots
• Obesity (BMI over 30)

Each of these conditions requires different management strategies during pregnancy. For example, if you have diabetes, you’ll need careful blood sugar monitoring throughout pregnancy to reduce the risk of birth defects, excessive fetal growth, and other complications. If you have epilepsy, your neurologist and obstetrician will work together to balance seizure control with medication safety for your developing baby.

The good news is that with proper management and monitoring, many people with pre-existing conditions have healthy pregnancies and babies. The key is working closely with your healthcare team, ideally starting before you conceive.

Health Problems That Develop During Pregnancy

Even if you started pregnancy completely healthy, certain conditions can emerge as your pregnancy progresses. These pregnancy-specific complications automatically move you into a higher-risk category.

Preeclampsia and eclampsia are serious conditions involving high blood pressure and organ stress. Preeclampsia typically develops after 20 weeks of pregnancy and can progress to eclampsia, which involves seizures. Warning signs include severe headaches, vision changes, upper abdominal pain, and sudden swelling. Without treatment, these conditions can be life-threatening for both you and your baby.

Gestational diabetes develops when your body can’t produce enough insulin to handle pregnancy’s increased demands. Unlike pre-existing diabetes, this form appears during pregnancy and usually resolves after delivery. However, it still requires careful management through diet, monitoring, and sometimes medication to prevent complications like excessive fetal growth or breathing problems for your baby after birth.

Placental complications such as placenta previa (when the placenta covers the cervix) or placenta accreta (when the placenta grows too deeply into the uterine wall) can cause dangerous bleeding and may require cesarean delivery. These conditions are typically discovered during routine ultrasounds.

Fetal growth restriction means your baby isn’t growing at the expected rate. This can happen due to placental problems, maternal health conditions, or other factors. Your doctor will monitor your baby’s growth closely through ultrasounds and may recommend early delivery if your baby would be safer outside the womb.

Rh sensitization occurs when your blood type is Rh-negative and your baby’s is Rh-positive, causing your immune system to create antibodies that can attack your baby’s blood cells. Fortunately, a simple injection during pregnancy can prevent this problem in most cases.

Severe anemia during pregnancy means you don’t have enough healthy red blood cells to carry adequate oxygen to your tissues and your baby. This can cause fatigue, weakness, and increase risks during delivery.

Your Previous Pregnancy History Matters

What happened in past pregnancies significantly influences your current pregnancy risk level. Your body has already shown how it responds to pregnancy, and patterns often repeat.

If you’ve experienced a preterm birth before (delivery before 37 weeks), you’re at higher risk for another preterm delivery. Your doctor may recommend progesterone supplementation or a cervical cerclage (a stitch placed in your cervix to help keep it closed) to reduce this risk.

A history of stillbirth or late miscarriage understandably creates anxiety about subsequent pregnancies. Your medical team will typically increase monitoring and may recommend additional testing to identify any treatable causes.

Previous preeclampsia increases your chances of developing it again. Your doctor might start you on low-dose aspirin early in pregnancy to reduce this risk.

If you’ve had a baby with a genetic condition or birth defect, genetic counseling can help you understand the likelihood of recurrence and what prenatal testing options are available.

Past uterine surgery, including cesarean delivery, myomectomy (fibroid removal), or treatment for cervical issues, can affect how your uterus handles pregnancy and delivery. Previous C-sections slightly increase the risk of placenta accreta, and you’ll need to discuss delivery options with your provider.

Carrying Twins, Triplets, or More

Multiple gestations automatically qualify as high-risk pregnancies because carrying more than one baby places extra demands on your body and increases the likelihood of complications.

Preterm birth is significantly more common with multiples. About 60% of twins and more than 90% of triplets are born preterm. Your babies share space and resources, which can trigger early labor.

Growth restriction affects multiples more often, especially if they share a placenta. Your doctor will monitor each baby’s growth through regular ultrasounds to ensure all babies are developing adequately.

Pregnancy-induced hypertension and preeclampsia occur at higher rates in multiple pregnancies. Your blood pressure will be checked more frequently, and you’ll be educated about warning signs to watch for at home.

Gestational diabetes is also more common when carrying multiples, likely due to the higher hormone levels produced by multiple placentas.

Both you and your babies face increased risks during pregnancy and delivery, which is why you’ll have more frequent prenatal visits and will likely deliver at a hospital equipped with a high-level neonatal intensive care unit.

Lifestyle Factors That Increase Pregnancy Risk

Certain lifestyle choices and circumstances directly impact pregnancy outcomes. While some of these factors may feel beyond your control, understanding them can help you identify areas where change is possible.

Smoking during pregnancy restricts blood flow to your baby, reducing oxygen and nutrient delivery. This increases the risk of preterm birth, low birth weight, birth defects, and sudden infant death syndrome (SIDS). Quitting at any point during pregnancy improves outcomes.

Alcohol consumption can cause fetal alcohol spectrum disorders, leading to physical abnormalities, developmental delays, and learning disabilities. No amount of alcohol has been proven safe during pregnancy.

Drug use, whether prescription medications not approved for pregnancy or illicit substances, can cause serious complications including birth defects, growth restriction, withdrawal symptoms in newborns, and developmental problems.

Nutrition and weight play crucial roles. Being underweight (BMI under 18.5) or having obesity (BMI over 30) both increase risks. Underweight mothers face higher rates of preterm birth and low birth weight babies. Obesity increases the risk of gestational diabetes, preeclampsia, blood clots, and complications during delivery. If possible, reaching a healthier weight before pregnancy is ideal, but healthy eating habits during pregnancy still make a meaningful difference.

Inadequate prenatal care means potential problems aren’t caught early. Regular prenatal visits allow your doctor to monitor your health and your baby’s development, catch complications when they’re most treatable, and provide education and support.

Infections That Complicate Pregnancy

Maternal infections can pose serious risks to pregnancy, affecting your health, your baby’s development, or both. Some infections are more dangerous when contracted during pregnancy than at other times.

HIV can be transmitted to your baby during pregnancy, delivery, or breastfeeding, but with proper treatment, the transmission risk can be reduced to less than 1%. All pregnant people are screened for HIV as part of standard prenatal care.

Hepatitis B and C can also be passed to your baby. Testing and appropriate management can reduce transmission risks and ensure your baby receives necessary treatment after birth.

Zika virus, primarily transmitted through mosquito bites, can cause severe brain abnormalities in developing babies. If you’re pregnant or planning pregnancy and live in or travel to areas with Zika transmission, protection against mosquito bites is critical.

COVID-19 poses increased risks during pregnancy, including higher chances of severe illness, preterm birth, and stillbirth. Vaccination is recommended for pregnant people to protect both mother and baby.

Rubella (German measles), if contracted during early pregnancy, can cause serious birth defects affecting the heart, eyes, ears, and brain. Most people are vaccinated against rubella as children, but immunity can wane.

Cytomegalovirus (CMV) is a common virus that’s usually harmless in healthy adults but can cause hearing loss, vision problems, and developmental delays if transmitted to a developing baby.

Toxoplasmosis, typically contracted through undercooked meat or cat feces, can cause brain and eye damage in babies infected during pregnancy.

Sexually transmitted infections including syphilis, gonorrhea, chlamydia, and herpes can cause serious complications if left untreated. Standard prenatal screening catches most of these early enough for effective treatment.

Social and Environmental Factors That Affect Pregnancy Outcomes

Pregnancy outcomes aren’t determined solely by biology and medical care. Where you live, your economic circumstances, and your environment all play significant roles in maternal and infant health.

Lower income often correlates with reduced access to quality prenatal care, nutritious food, safe housing, and healthcare resources. These barriers create real health risks that go beyond individual choices.

Lack of access to prenatal care means complications aren’t identified or treated early. Transportation challenges, work schedule conflicts, lack of insurance, or shortage of obstetric providers in your area can all create barriers to getting the care you need.

Chronic stress, whether from financial strain, unsafe living conditions, discrimination, or other sources, affects your body’s stress hormones and inflammatory responses. Research shows chronic stress during pregnancy increases risks for preterm birth and low birth weight.

Environmental exposures to lead, air pollution, pesticides, or other toxins can affect both your health and your baby’s development. These exposures are often concentrated in lower-income communities and communities of color due to historical housing and zoning policies.

Racial and ethnic disparities in maternal and infant outcomes persist even after accounting for income, education, and insurance status. Black and Indigenous women face significantly higher rates of maternal mortality and severe complications compared to white women with similar health profiles. These disparities reflect the cumulative effects of systemic racism, including differences in how pain is addressed, how symptoms are taken seriously, and implicit bias in medical care.

Understanding these social determinants of health helps explain why pregnancy outcomes vary so widely and underscores the importance of addressing systemic barriers to equitable care.

What High-Risk Status Means for Your Prenatal Care

Being labeled high-risk doesn’t just mean something might go wrong. It means you’ll receive more intensive monitoring and specialized care designed to prevent complications or catch them early when they’re most treatable.

You’ll have more frequent prenatal visits than standard monthly or bi-weekly appointments. Depending on your specific risk factors, you might see your doctor every two weeks or even weekly during certain periods of your pregnancy.

Additional ultrasounds will track your baby’s growth, amniotic fluid levels, placental location, and overall development. Some high-risk pregnancies require ultrasounds every few weeks rather than the standard two or three during an entire pregnancy.

More blood work helps monitor conditions like gestational diabetes, anemia, or medication levels if you’re being treated for a chronic condition. You might also have specialized tests like amniocentesis or chorionic villus sampling if there’s concern about genetic conditions.

Fetal monitoring may include non-stress tests, where your baby’s heart rate is monitored to assess well-being, or biophysical profiles combining ultrasound with heart rate monitoring.

You’ll likely work with a maternal-fetal medicine specialist (perinatologist) in addition to your regular obstetrician. These doctors have additional training in managing high-risk pregnancies and can provide specialized care while coordinating with your regular provider.

A multidisciplinary team approach means various specialists collaborate on your care. Depending on your situation, this might include endocrinologists, cardiologists, hematologists, nutritionists, social workers, and neonatal specialists.

Your delivery will likely be planned more carefully, potentially at a hospital with a higher-level neonatal intensive care unit (NICU) and specialists available 24/7. Early delivery might be recommended if continuing the pregnancy poses more risk than the challenges of prematurity.

Understanding Your Personal Risk Factors

According to the CDC, approximately 66% of women of reproductive age have at least one risk factor for birth defects, and about 10% have three or more risk factors. This doesn’t mean most pregnancies will have serious complications. It means most people have something that requires a bit of extra attention.

Your personal risk profile is unique. Having one risk factor doesn’t necessarily make your pregnancy high-risk, but multiple factors often compound each other. For example, being over 35 with well-controlled asthma might not significantly increase your risk, but being over 35 with uncontrolled diabetes and obesity creates substantially higher risk.

Some risk factors you can’t change, like your age or pregnancy history. Others, like smoking, nutrition, or managing chronic conditions, offer opportunities for reducing risk through lifestyle changes or medical management.

Preconception care, ideally starting three months or more before you try to conceive, allows you to optimize your health before pregnancy begins. This might mean getting chronic conditions under better control, taking folic acid supplements, adjusting medications to pregnancy-safe alternatives, or addressing nutrition and weight concerns.

Even if you’re already pregnant and have multiple risk factors, early and consistent prenatal care significantly improves outcomes. Most high-risk pregnancies result in healthy babies when complications are identified and managed appropriately.

Moving Forward with Information and Support

Learning you have a high-risk pregnancy can feel frightening, but knowledge is genuinely powerful in this situation. Understanding what makes your pregnancy higher risk helps you know what symptoms to watch for, what questions to ask your medical team, and what you can do to give yourself and your baby the best possible outcome.

High-risk doesn’t mean high-probability of disaster. It means you need closer watching and specialized care. With today’s medical technology and knowledge, most high-risk pregnancies end with healthy mothers and healthy babies. Early and regular prenatal care truly makes a difference, even when risk factors exist that can’t be eliminated.