6 factors that raise the risk of a complicated pregnancy

Advanced maternal age is believed to be associated with adverse pregnancy outcomes. “If women are above 35, it doesn’t necessarily mean there will be a high-risk pregnancy as most of them do conceive and deliver healthy babies,” says Dr Prashanth Hegde, Specialist Obstetrician and Gynaecologist at Thumbay Hospital. “Having said that, they are considered high-risk as there is a potential risk related to their age.”

Causes: Older pregnant women carry a higher risk of miscarriage, having genetically abnormal or anomalous babies, medical conditions coexisting with pregnancy and premature births.

Management: Preconception consultation, screening, counselling and close medical surveillance during pregnancy are vital for these women to reduce risk.

Maternal health problems

Medical conditions that exist before conception such as high blood pressure, diabetes, epilepsy, thyroid disease, heart or blood disorders, asthma and infections can pose a threat to a pregnant woman. “These medical conditions can have an effect on both the mother and the unborn baby,” says Dr Sarah Francis, Consultant Obstetrics and Gynaecology at American Hospital Dubai. “The medication used to control and manage these conditions also could have adverse effects on a developing baby and result in miscarriages, birth defects or abnormalities, premature delivery and worst-case scenario, a stillbirth. Effects on the mother could include uncontrolled high blood pressure leading to seizures, caesarean deliveries, birth trauma and haemorrhage.”

Management: Women with any of these conditions should speak to their doctor before they plan a pregnancy. “The aim is to ensure optimal control of their medical condition before they embark on pregnancy and change their medication to other medicines that are safer for the baby,” says Dr Francis. “In intractable medical cases, joint medical care is provided, for instance, a respiratory specialist and an obstetrician can together manage a women with asthma during her pregnancy.”

Lifestyle choices

Some habits or behaviours such as smoking, drinking alcohol and bad eating habits can pose potential risks to the baby’s development inside the womb. “Smoking can lead to premature delivery,” says Dr Francis.

“Also, alcohol and smoking can affect the baby’s growth in the womb, making the baby smaller in size. Depending on the amount taken during pregnancy, it could also affect the baby’s brain development.”

Management: “Some women may be able to stop smoking immediately,” says Dr Francis. “However, they may suffer symptoms of irritation, low mood and anxiety for the first few weeks. This can be managed with the support of family and friends and engaging in a new activity/hobby as a means of distraction. Other women may prefer reducing the amount of cigarettes to a period or look for nicotine replacement.

In a few cases when all these methods have failed, medication can be taken. All options have to be discussed with a healthcare professional.”

Similarly, if there are difficulties stopping alcohol intake, seek help from a doctor. A balanced diet is important, as this ensures that the baby gets the essential nutrients required for growth and development.

Multiple births

“The most common risk for women carrying multiple babies is the possibility of premature delivery,” says Dr Hegde. “The mother is also at risk of developing high blood pressure and diabetes during pregnancy. There’s a danger of growth impairment of babies and in rare cases anomalous babies.”

Causes: Women with a family history of mother or sisters having twins/triplets and over the age group of 30-35 years are more likely to have multiple births. “Additionally, use of fertility medications and infertility treatment modalities such as assisted reproductive technologies like IVF also increases the chances of multiple pregnancies,” says Dr Hegde.

Management: “Early diagnosis of multiple births, increased maternal nutrition, frequent prenatal visits coupled with specialised care by a maternal-foetal medicine specialist should help a woman with multiple pregnancies.”

History of miscarriages

Miscarriages in the past, problems with a previous pregnancy, or a family history of genetic disorders are also risk factors for a pregnancy. “Unfortunately, some of these risk factors are non-avoidable,” says Dr Francis. “Miscarriage is the loss of a pregnancy before the fifth month of pregnancy (before 20 weeks).

Causes: In many cases, there is no obvious cause. Some miscarriages however are due to abnormal genes or chromosomes, which can either be inherited or occur by chance.

In other cases, the woman’s health condition can lead to miscarriages. Thyroid disease, poorly controlled diabetes, or infections may increase the risk of miscarriage as well as lifestyle habits.

Management: Identifying risk factors early on before a subsequent pregnancy, treating underlying medical conditions and counselling the woman on healthy lifestyle habits can play a role in reducing the risk.

History of preterm labour

Previous preterm labour or premature delivery increases the risk of the same during a pregnancy. “Babies born before 25 weeks have a very high risk of long-term problems, including learning disabilities and neurological problems,” says

Dr Nashwa Abuhassan, Consultant Obstetrics and Gynaecology at Dr Sulaiman Al Habib Hospital. “About 20 per cent of these babies will be severely disabled.”

Causes: Risk factors include carrying multiple foetuses, a history of premature labour, weak cervix, and certain vaginal infections.

Management: There are no medications or surgical procedures to stop preterm labour, other than temporarily. “Corticosteroids can help promote baby’s lung maturity,” says Dr Hassan. “Tocolytics are medication that temporarily slow down or stop contractions to allow corticosteroids to provide the maximum benefit for the fetus. Cervical cerclage (the cervix is stitched closed) is offered if preterm labour occurs because of a short cervix.”