What is meant by the term 'higher risk' pregnancy?

A higher risk pregnancy is when the parent or baby have a greater chance of problems happening during the pregnancy or birth. This may be because you have health issues (because of your pregnancy, or unrelated to being pregnant) or if tests show your baby has health issues. If you had a problem in a previous pregnancy, your doctor may consider this pregnancy to be higher risk.

It is important to remember that risk in pregnancy exists on a sliding scale, and pregnancies are not simply ‘high risk’ or ‘low risk’.

What causes a pregnancy to be considered higher risk?

There are many reasons your pregnancy might be considered higher risk.

Some examples include the following:

Causes related to you

• smoking in pregnancy
• drinking alcohol or illicit drug use in pregnancy
• living with obesity
• being aged under 20 or over 40 years old
• having high blood pressure or high risk of pre-eclampsia
• pre-existing medical conditions (such as epilepsy, diabetes, asthma, kidney disease, heart disease, autoimmune disease or any condition for which you have ongoing care from a doctor)
• severe mental illnesses

Causes related to your baby

• having a baby that is measuring small at your pre-natal checks
• multiple pregnancy (twins or more)
• symptoms that suggest you may give birth pre-term (early) in this pregnancy

Risk factors related to your previous pregnancy

• losing a previous pregnancy
• giving birth pre-term
• having diabetes in pregnancy

Having your first appointment (also known as a booking appointment) with your maternity care provider later than the recommended time (usually around 12 weeks of pregnancy) is also associated with poorer pregnancy outcomes.

How might my care be different if I have a higher risk pregnancy?

If you have a higher risk pregnancy your doctor will watch your pregnancy more closely and may be more involved throughout the process. This may mean more blood tests, ultrasound scans or appointments with obstetricians that specialise in higher risk pregnancies, such as maternal fetal medicine specialists.

Depending on your health situation, you may also need to start taking medicine. If you have high blood pressure, you will need to go to hospital or health centre for blood tests, blood pressure checks and to monitor your baby’s heart rate.

Are there any risks to my health or my baby's health if the pregnancy is considered higher risk?

The specific risks to you or your baby’s health change depending on what conditions and risk factors you or your baby have. Some examples of the risks are listed below, but they vary widely, and you may not have any of these risks.

Risks to you may include:

• blood clots
• kidney or liver failure
• stroke or seizures
• abnormal bleeding
• gestational diabetes
• high blood pressure or pre-eclampsia

Risks to your baby may include:

• higher rate of miscarriage
• abnormal growth — being smaller or bigger than normal
• development problems with the brain or spine
• being born premature
• needing care in a special care nursery in hospital
• stillbirth

What are my birth options if I have a higher risk pregnancy?

The options for the type and timing of your birth will depend on your specific needs. You will need to give birth in a birth suite that has the right staff and equipment to care for the medical conditions that you and your baby have.

Your birth choice should be a shared decision between you and your doctor. Shared decision making involves your doctor giving you your options for labour and birth, and making a recommendation if they have one. You will discuss what is important to you in your birth experience and have the chance to ask any questions. Together, you will then make a decision that is right for you and your baby.

If you baby needs to be born but you are not yet in labour, your health team may recommend an induction of labour. This may occur if you have a medical condition that means continuing the pregnancy for too long adds to the risk of more problems, such as with high blood pressure.

Sometimes your baby will be born by caesarean section. This may be an elective (planned) caesarean section, for example, if you have twins. You may need an emergency caesarean if there is concern for your baby’s wellbeing or there is life threatening emergency.

Your doctor will explain to you why they are recommending a caesarean section. They will make sure you understand the risks of having or not having the operation so you can give informed consent.

Resources and support

Mercy Perinatal has information about conditions that can make your pregnancy higher risk.

The Royal Australian College of Obstetricians and Gynaecologists (RANZCOG) has an information sheet about high blood pressure in pregnancy and pre-eclampsia.

RANZCOG has a patient factsheet about why your weight matters during pregnancy.

The Baby Coming You Ready website has information about pregnancy for Aboriginal and/or Torres Strait Islander people.

The Australian Diabetes in Pregnancy Society has a diabetes in pregnancy brochure for Aboriginal and/or Torres Strait Islander people.

Diabetes Australia has a range of videos about diabetes in pregnancy in many community languages.