Kara Stone expected to be considered high risk when she had her first son two years ago. Not only was she 35 at the time — advanced age is one of the most common risk factors for a high-risk pregnancy — but she has the autoimmune disease lupus. What she didn’t expect was pre-eclampsia.
The potentially fatal blood pressure disorder can impact all of a woman’s organs. Some of the more common pre-eclampsia symptoms include high blood pressure and an abnormal amount of protein in the urine. Other more severe symptoms include a low number of platelets in the blood, pain in the upper abdomen, changes in vision, fluid in the lungs and severe headaches.
“There is nothing that can prepare you. I was a first-time mom and I had no idea,” says Stone, who lives in Edgewood, Maryland.
The National Institutes of Health estimates that pre-eclampsia occurs in 2 to 8 percent of pregnancies, and more so in African-American and Latina women than in white moms-to-be.
It’s just one of many factors that can occur before or during pregnancy that make it high risk. Pre-eclampsia, HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets), high blood pressure, kidney problems, urinary tract infections and diabetes are all factors that can designate any pregnancy high risk, but these complications are more common in pregnant women with lupus, like Stone. Other scenarios that can make a pregnancy high risk include pregnancy with twins or more multiples, smoking or abuse of alcohol or illicit drugs while pregnant. The mother’s age at her first pregnancy and existing conditions such as thyroid disease or obesity can also influence whether a pregnancy is considered high risk. In addition, all pregnancies come with a 15 percent risk for miscarriage.
Dr. Linda Marie Szymanski, medical director of labor and delivery and inpatient obstetric services at The Johns Hopkins Hospital, says women who have conditions or attributes that make them likely candidates for a high-risk pregnancy should plan ahead and meet with a maternal-fetal medicine physician to prepare for as healthy a pregnancy as possible. They often need more intensive screening tests to pinpoint issues. The selection of tests depends on the woman’s underlying condition, Szymanski says. A woman who already has high blood pressure, say, will undergo blood tests to determine kidney and liver function, giving the medical team a better idea of her baseline health. This way, if she becomes sicker, doctors know what to look for.
Women with high-risk pregnancies also have an increased risk for preterm birth — or babies born before 37 weeks gestation. Premature babies are at risk for breathing problems, heart defects, jaundice — or yellowing of the skin — and other conditions that could land them in a neonatal intensive care unit. In addition to an OB-GYN, women with a high-risk pregnancy may require a multidisciplinary team of specialists to not only monitor their pregnancy, but their health as well. For instance, if a woman has an autoimmune disease, she may need to continue seeing a rheumatologist to ensure her pregnancy is not worsening her condition.
For lupus patients like Stone, it’s safest to wait to become pregnant until symptoms have been inactive for six months. Stone’s condition was under control and continued to be throughout her entire pregnancy. However, due to pre-eclampsia, Stone was put on bed rest at 32 weeks, and at 37 weeks, her medical team chose to induce her.
More complications arose, and the epidural didn’t work. “The cord was wrapped around his neck. While I was having contractions, I had to stop pushing for them to pull the cord up over his head,” Stone says. “Then, the placenta got stuck and I had extreme anemia from the whole delivery.”
While she was pregnant with her second son, born 14 months later, she developed gestational diabetes. Stone’s pregnancies are on the more serious side of the high-risk spectrum. For those who are otherwise healthy but are of advanced maternal age — 35 and up — it’s important to consider potential chromosomal abnormalities in the baby, Szymanski says.
There are a number of screenings and diagnostic tests available for these women, she explains. Amniocentesis can catch or rule out chromosomal abnormalities in the baby. Women require counseling with a doctor to help them decide whether the test, which comes with a small risk of pregnancy loss, will be beneficial, including knowing versus not knowing about an issue in advance.
Obesity also greatly increases the likelihood of having a high-risk pregnancy, and it’s on the rise. New findings published in JAMA Internal Medicine indicate that more than two-thirds of Americans are now overweight or obese. That’s up from previous estimates of more than one-third (or 78.6 million) reported by the Centers for Disease Control and Prevention.
The more overweight a woman is, the greater her risk for pre-eclampsia and gestational diabetes. It may even be difficult to monitor the baby’s development on ultrasound due to thicker amounts of fatty tissue, Szymanski says. During delivery it can be much more difficult to monitor the fetus’ heart rate. “They’re also at an increased rate for having a larger baby and requiring a [cesarean section].”
That’s why it’s important to talk to a maternal-fetal medicine physician or an OB-GYN about ways to manage any health conditions before and during pregnancy.
Candace Hurley, founder Sidelines, an international nonprofit aimed at supporting women and families through a high-risk pregnancy, says women should be armed with an arsenal of questions before they go to their first appointment.
Because the appointments can feel stressful, Hurley, of Laguna Beach, California, recommends bringing a notebook or having a mobile device handy to log what the doctor says and any concerns that arise between visits.
“The patient should be just as involved in asking questions, really making sure she is educated and feels like the most important part of the team,” Hurley says. “The doctor should make her feel that way. If the doctor is saying, ‘don’t worry about it. I’ll take care of everything,’ that’s probably not something you want.”
A woman should also ask how often she will be seen by the doctor or nurse, if there will be multiple ultrasounds to monitor the baby’s movement, breathing and heart rate, what type of prenatal testing will be done, when or if to stop current medications, and how much the doctor will monitor the pregnancy based on health condition. Trust your gut. If it seems like questions aren’t being answered, ask again or ask someone else, Hurley says.
Ultimately, high-risk pregnancies take a great deal of patience and perseverance for both moms and doctors. “Once you have that baby in your arms, you forget about all of it,” Stone says. “It’s the best feeling in the world. To know you fought so hard to have your child healthy.”
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When Your Pregnancy Is High Risk originally appeared on usnews.com
