There are many emotions to experience throughout pregnancy. Knowing what to look for and expect with a high-risk pregnancy is sometimes part of that journey. If a doctor deems a pregnancy “high-risk,” you and your baby may need special care and monitoring.

With high-risk pregnancies, patients may experience extreme fatigue, ongoing abdominal or chest pain, nausea, heart palpitations, vomiting, and trouble breathing. However, some patients may be high-risk without having any symptoms.

OB-GYN and fellowship-trained in Maternal Fetal Medicine Rebecca Rimsza, MD, explains the many reasons a pregnancy can be considered high-risk.

“Pre-pregnancy maternal health conditions are often high risk, but other issues such as prior pregnancy complications or fetal birth defects are also common reasons for high-risk pregnancies,” says Dr. Rimsza.

Additional factors that make a pregnancy high risk include:

1. Age

“When we think of age in pregnancy, we consider 35 the ‘advanced maternal age’ and worthy of additional monitoring,” says Dr. Rimsza. “However, most patients over 35 have completely normal and healthy pregnancies. Risks increase once patients are over 40, and those pregnancies need close monitoring.”

“Older” first-time mothers are at higher risk for miscarriage, pregnancy-related high blood pressure, delivery complications, and gestational diabetes. Pregnant teenagers are also considered high risk as they may be less likely to get prenatal care or keep regular prenatal appointments. Teens often don’t know whether or not they have sexually transmitted infections that can cause problems with pregnancy.

2. Illness

“Illnesses such as hypertension, autoimmune diseases, and diabetes can make a pregnancy high-risk,” says Dr. Rimsza. “Very high-risk pregnancies occur for patients with prior heart disease, maternal cancer, or an organ transplant.”

Other existing health conditions that can make a pregnancy high-risk include polycystic ovary syndrome, kidney disease, thyroid disease, obesity, and HIV. These conditions can contribute to difficult births and problems for the fetus.

3. Lifestyle factors

Smoking and drug addiction can cause serious complications throughout pregnancy. Tobacco use causes congenital disorders and sudden infant death syndrome (SIDS). It also increases the chances of stillbirth or fetal death.

Drinking alcohol during pregnancy increases a baby’s risk for fetal alcohol spectrum disorders and SIDS. Additionally, women who drink during pregnancy are more likely to have a miscarriage or stillbirth.

4. Preeclampsia

“Preeclampsia is a complication unique to pregnancy,” says Dr. Rimsza. “Someone at least 20 weeks pregnant experiences very high blood pressure that causes a risk of seizure and stroke. It’s also a reason doctors may recommend an early delivery. Generally, preeclampsia improves following delivery, though for some, it may be present postpartum.”

Preeclampsia might be caused by the placenta, but the exact cause is unknown. It increases the resistance of blood flow from the placenta to the fetus, which can cause pre-term delivery and restricted fetal growth. In patients, preeclampsia affects the brain, liver, and kidneys. The condition can be fatal and cause long-term problems for the fetus and the pregnant individual.

5. Gestational diabetes

“This occurs when the pregnancy hormones cause elevated blood glucose levels,” says Dr. Rimsza. “It becomes more common as the pregnancy progresses. All patients are screened for gestational diabetes in the early third trimester, and those at the highest risk need first-trimester screening.”

Dr. Rimsza explains that it’s critical to diagnose gestational diabetes because uncontrolled blood glucose causes further pregnancy complications, including pre-term delivery, NICU admissions, or cesarean delivery.

6. In vitro fertilization

“The vast majority of IVF pregnancies are uncomplicated, but some risks become elevated enough for an OB-GYN to recommend a high-risk obstetrician,” says Dr. Rimsza. “IVF pregnancies experience a higher rate of preeclampsia and birth defects needing screening via ultrasounds. We recommend additional monitoring once a pregnancy reaches 36 weeks, and sometimes an early delivery is recommended.”

Every pregnancy is different, and the reasons for high risk will vary from person to person. It’s always best to consult with your health care provider about specific risks and questions. Patients can also be referred to perinatologists, OB-GYNs with additional training for high-risk pregnancies.

“Nothing can make a pregnancy without risk, but a perinatologist is there to help identify each patient’s risks and recommend management strategies and medications,” says Dr. Rimsza.