What is a high-risk pregnancy?

You may find it strange that there is no single accepted definition of what constitutes a high-risk pregnancy. Some women will have a risk factor, such as advanced maternal age which poses some increased risks, but where no change in pregnancy care is needed. Other women have an underlying condition such as diabetes, high blood pressure, or kidney disease where special care and increased monitoring are key to reducing the chances of complications. I would define a high-risk pregnancy as one where the woman or fetus has a condition which will benefit from additional measures or treatments, which could include adding medications, procedures, or ultrasounds to optimize the pregnancy's prognosis. In addition to the conditions listed above, other conditions which would make a pregnancy high-risk would include maternal heart disease, diagnosed fetal birth defects, certain infections, and twin or triplet gestations. All of these conditions require extra measures in addition to routine prenatal care to protect the health of the mother and her baby.

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Who should be cared for by a Maternal-Fetal Medicine Specialist?

Not all pregnancy risk factors require evaluation and care by an MFM subspecialist. Many are withing the scope of expertise of obstetric generalists. Occasionally, a general obstetrician or a midwife will refer a patient to an MM subspecialist for a consultation to assess the level of risk and create a plan of care. The patient will then return to the referring provider for her ongoing prenatal care and delivery. Some MFM physicians only provide this type of consultative care and do not perform deliveries, while other MFM practices care for the patient during the entire pregnancy and post-delivery (postpartum) period.

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What are some of the high-risk conditions frequently seen by MFM subspecialists?

Patients referred to an MFM subspecialist can include those with diabetes, high blood pressure, autoimmune disorders such as lupus erythematosus, kidney disease, and heart conditions. They can also be referred if the fetus is thought to  have a birth defect or a genetic disorder, or if the pregnancy has been found to have a complication such as preeclampsia, premature labor, cervical insufficiency, or placenta previa. Patients with triplets and some with twins are referred as well.

 

How old is too old to have a baby?

There is no upper age limit for having a baby. As women enter their forties, their chances of conceiving diminish significantly, and if they do get pregnant, the chances that the baby will have a chromosomal abnormality like Down syndrome increase. Infertility treatments such as IVF are available for those women who cannot conceive spontaneously, and this is now available for women even in their fifties. There are some increased risks that come with age, including risks of preeclampsia, gestational diabetes, and miscarriage, and it is often more tiring to be pregnant if over forty. However, the odds of a successful pregnancy outcome are still favorable.

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Over the years, I have cared for many pregnant women in their fifties, and even one in her sixties. Most women who are in good health entering pregnancy, and those with an underlying medical condition that is well controlled, will have a favorable prognosis. With the appropriate care and some extra testing, women beyond the age of thirty-five will most likely have a healthy child without a major risk to their health.