Handling High-Risk Pregnancy: The Role of a Specialist

TL;DR:

A pregnancy is considered high-risk when medical, maternal, or foetal factors increase the likelihood of complications.
While many OB-GYNs can manage moderate-risk cases, high-risk pregnancies often benefit from co-management with a specialist.

Hearing the term “high-risk pregnancy” during a routine OB‑GYN visit can be unsettling. Understandably, your mind might leap to worst-case scenarios. But it doesn’t always point to something dangerous or imminent. Basically, it means your pregnancy needs closer monitoring and possibly more specialised care to protect you and your baby.

So, what exactly qualifies as high-risk? Can your current obstetrician continue managing your pregnancy, or should you ask for a referral? And how do you choose the right specialist if needed?

When Is a Pregnancy Considered High-Risk?

A pregnancy is considered high-risk when there’s a greater chance of complications that could affect your health, your baby’s health, or both. This classification is based on specific medical factors — either present before pregnancy or developing during it — and helps your care team determine the level of monitoring and support you may need.

Here are common reasons a pregnancy may be classified as high-risk:

1. Age-Related Risks

35 Years or Older: This age group has a slightly higher chance of complications such as high blood pressure, gestational diabetes, and chromosomal conditions like Down syndrome.

Under 17 Years Old: Younger mothers may be more likely to experience preterm labour, anaemia, or babies with low birth weight due to physical and nutritional factors.

2. Pre-Existing Health Conditions

If you have ongoing medical conditions, your pregnancy may need more careful monitoring. These include:

Diabetes (Type 1 or 2): May lead to high birth weight, birth complications, or low blood sugar in the newborn if not well controlled.
High Blood Pressure: Can affect how the placenta functions, increasing the risk of growth issues or preeclampsia (a dangerous blood pressure disorder).
Heart or Kidney Disease: These can make it harder for your body to adapt to the increased physical demands of pregnancy.
Autoimmune Diseases: May increase the risk of miscarriage, early delivery, or placenta-related problems.
Thyroid Conditions: If untreated, can affect your baby’s brain development or increase the risk of miscarriage.

3. History of Complications in Previous Pregnancies

Your specialist may classify your pregnancy as high-risk if you’ve previously had:

Preterm labour (delivery before 37 weeks)
Recurrent miscarriages
Stillbirth
A baby with congenital abnormalities
Surgery on the uterus, such as a classical Caesarean or fibroid removal

4. Conditions That Develop During Pregnancy

Even if you begin pregnancy in good health, some conditions can arise that increase the risk, including:

Gestational Diabetes: A type of diabetes that develops during pregnancy, often managed through diet or medication.
Preeclampsia: A blood pressure disorder that usually occurs after 20 weeks, potentially affecting organs like the liver or kidneys.
Foetal Growth Restriction: When the baby isn’t growing at the expected rate, often due to issues with the placenta.
Too Much or Too Little Amniotic Fluid: This may be associated with how the baby or placenta is functioning.
Placenta Previa: When the placenta sits low and blocks the cervix, it may lead to bleeding and can affect delivery planning.

5. Carrying More Than One Baby

Expecting twins or more automatically classifies a pregnancy as high-risk. The body works harder to support multiple babies, and there is a higher chance of early delivery or uneven growth between babies. These pregnancies usually require more scans and a detailed delivery plan.

6. Foetal Conditions

Your pregnancy may also be considered high-risk if your baby is found to have:

A structural issue, such as a heart defect or spinal abnormality.
A genetic or chromosomal condition, like Down syndrome or Edwards syndrome.
Irregular heartbeat or other concerns found during screening.

Think your pregnancy may fall into one of these categories? Connect with our team to receive the specialised care and monitoring you may need.

Can Your Obstetrician Handle a High-Risk Pregnancy?

Many obstetricians are trained to manage moderate-risk pregnancies and can oversee a range of complications with appropriate monitoring. However, not all high-risk pregnancies can or should be managed by a general OB-GYN alone.

Your obstetrician may continue managing your pregnancy alone if:

Your condition is stable and well-controlled.
The risk is low to moderate, according to clinical evaluation, and doesn’t require specialised interventions.
You’re already under close monitoring and responding well to care.

Referral to a maternal-foetal medicine (MFM) specialist, also known as a high-risk pregnancy doctor, is generally recommended when:

Complex foetal conditions are found, like congenital anomalies or growth restriction.
You have a serious or multiple medical conditions, as listed above.
There are complications with the placenta.
Preterm labour risk is high, or cervical insufficiency is suspected.
Advanced imaging or genetic testing is required depending on clinical findings.

In most cases, your OB-GYN and MFM specialist can co-manage a high-risk pregnancy. This can support continuity of care while giving you access to the right diagnostics, targeted treatments, and specialist consultations when needed.

How to Select the Right High-Risk Pregnancy Doctor

An MFM specialist is trained to manage high-risk pregnancies using specific diagnostic tools and treatment plans.

1. Qualifications and Experience

Board certification in maternal-foetal medicine.
Experience managing cases similar to yours.
Affiliation with a hospital or clinic that provides access to NICU (neonatal intensive care) if needed.

2. Communication and Coordination

Willingness to work alongside your primary OB-GYN.
Clear explanation of medical findings and treatment plans.
Open to answering questions and addressing concerns in understandable terms.

3. Patient Support and Accessibility

Availability for urgent concerns or follow-up appointments.
Access to diagnostic imaging, lab tests, and specialised care within the same facility or network.
Positive patient feedback or reviews can help guide selection, but should be considered alongside clinical expertise.

Your OB-GYN will typically refer you to an MFM specialist within their network. But you can always ask about other available options, especially if you have specific needs, preferences, or if a second opinion is warranted.

High-Risk Pregnancy Care: What Are the Next Steps?

If your pregnancy is classified as high-risk, your care plan will typically include:

1. Increased Monitoring

More frequent prenatal visits. It could be biweekly or weekly in later trimesters.
Regular growth scans, non-stress tests, or Doppler ultrasounds, depending on the condition.
Ongoing lab tests to track markers such as blood sugar, blood pressure, and kidney or liver function.

2. Individualised Treatment Plan

Medical management of any chronic or pregnancy-induced conditions.
Nutrition, physical activity, or medication recommendations tailored to your condition.
Preventive treatments such as corticosteroids for lung development in the case of early delivery risk.

3. Delivery Planning

Discussions around timing and mode of delivery.
Coordination with anaesthesia, neonatology, and, if necessary, surgical teams.
Early delivery may be recommended if maternal or foetal conditions worsen.

4. Postnatal Care and Follow-Up

Continued monitoring after birth, especially for conditions like preeclampsia or postpartum diabetes.
Assessment of the newborn for any expected or unexpected complications.
Planning for future pregnancies, if applicable, including risk reduction strategies.

The goal of high-risk pregnancy care is not only to manage complications but also to give you a structured, informed path forward.

With coordinated and appropriate care, many high-risk pregnancies progress safely.