For many women, finding out they’re pregnant is a moment filled with joy and anticipation. But that joy can be replaced with worry and concern if their pregnancy is high-risk.

According to the National Institutes of Health, a high-risk pregnancy is one in which a mother, her baby or both are at higher risk for problems during pregnancy or delivery than in a typical pregnancy. Some pregnancies become higher risk as they progress; some women are at an increased risk even before becoming pregnant.

Risk factors that may put women and their babies at a higher risk for problems include:

• Advanced maternal age (over 35)

• Smoking, alcohol and/or drug use

• Infectious diseases

• Multiple births (twins, triplets or more)

• Preexisting maternal health problems, such as high blood pressure, diabetes or epilepsy

• BMI over 30

• Previous pregnancies with complications

“We’re seeing metabolic syndrome, diabetes and high blood pressure more often as the general population is becoming more overweight and trending toward a less healthy lifestyle,” said Dr. Emily Riggs, an OB-GYN with Lawrence OB-GYN Specialists. “All of those can elevate the potential for a woman to have a high-risk pregnancy.”

Lauren Woodward didn’t have any pre-existing health conditions before she got pregnant. It took her by surprise when she was diagnosed with gestational diabetes last year during her third trimester.

“You get this diagnosis and think, ‘Okay, now what?'” she said. “I met with the LMH Health diabetes educators and they laid it all out for me — there wasn’t anything that I did to cause me to develop gestational diabetes. It was just a side effect of the placenta that changed how my body could process glucose.

Woodward said the educators taught her to manage her diabetes through her diet and how to use a glucometer.

“I felt a lot better after that appointment. Having a plan was a real relief,” she said.

Caring for high-risk patients

There’s no one-size-fits-all formula when caring for women with high-risk pregnancies. Riggs said it is standard care to screen all women with risk factors. For example, women with advanced maternal age are screened for thyroid disease in addition to other things.

Riggs also said that just because a pregnancy is high-risk, it doesn’t necessarily exclude you from using a midwife.

“We’ve spent time reviewing certain criteria and evidence-based literature to determine who would risk out of midwifery care. Our midwives still see patients with risk factors such as those who have a BMI up to 40 or patients with diet-controlled gestational diabetes,” she said. “If they develop a need for medications, they would move to physician care for closer monitoring.”

Recognizing the role of mental health

It’s not just physical health problems that affect pregnancy; mental health has a big impact, too.

“People don’t think about mental health and it’s overlooked as being a real medical condition,” Riggs said. “There’s a lot of stigma, and women fear that it will make them look like they aren’t ‘fit’ parents. In reality, we need to help women realize mental health is something to focus on and improve, like exercise and eating better.”

That’s where Melissa Hoffman comes in. Hoffman is a board-certified psychiatric mental health nurse practitioner who cares for patients at Lawrence OB-GYN Specialists. She said being on mental health medication and having a healthy pregnancy aren’t mutually exclusive — patients can balance their mental health needs with a healthy pregnancy.

“For someone considering pregnancy, consulting with a mental health provider prior to conception is ideal,” Hoffman said. “Many psychiatric medications are compatible with pregnancy and lactation. If adjustments to medications are recommended, that’s ideally done prior to pregnancy whenever possible.”

What if you’ve become pregnant already or develop a need for help during your pregnancy?

Hoffman said women should have a conversation with their health care provider about a risk-benefit analysis of untreated mental illness.

“There are many options to treat mental health needs in pregnancy, including psychotherapy, peer support and medication use,” she said.

Misconceptions about high-risk pregnancy

One common misconception about high-risk pregnancy has to do with clinics like the one Riggs works at. She said some people think the clinic only cares for low-risk patients.

“The providers at Lawrence OB-GYN Specialists see and deliver the majority of our high-risk patients. We all perform C-sections and deliver twins,” she said.

Sometimes a high-risk condition may not present itself until a mother is already at the hospital and in labor. That was the case when Caitlin Laird was in labor with her son two years ago.

“I’ve never had blood pressure issues throughout my life. Maybe four to six hours before he was born, mine shot through the roof. I had to have magnesium sulfate and had my pressure checked every half hour,” she said. “After Grant was born, it started to go down.”

Level 2 nursery provides care for infants

When Laird didn’t have a lot of blood pressure issues during her second pregnancy, she didn’t think much of it when she went to see Riggs for her 38-week check.

“When (nurse) Carrie came in and took my blood pressure, that’s when everything changed. It was really high and Dr. Riggs wanted me admitted that day,” Laird said. “Carrie wheeled me straight to labor and delivery from the office. I had to be induced because my pressure was so high.”

When Grace was finally born, she wasn’t breathing properly and had to be intubated. She was later taken by helicopter to Overland Park for additional care when the team discovered Grace had either meconium or a piece of the placenta in her lungs.

LMH Health’s Level 2 Special Care Nursery cares for babies as young as 34 weeks, including babies with respiratory problems and feeding difficulties or those who require antibiotic and IV therapy.

“If babies need specialized care, our pediatric hospitalists are immediately available 24/7 to work with nursing and other hospital staff to provide appropriate treatment and stabilization,” said Lori Tillema, director of maternal child services. She also said that staff has immediate access to neonatal consulting services through Sunflower Neonatology, which can provide guidance on various conditions.

While Laird said she was scared for her daughter, she knew Grace was in good hands.

“I can’t say enough about Dr. Riggs and the staff, nurses and doctors in labor and delivery. Everyone was so kind and they made it a more comfortable process,” she said.

What can I do to lower my risk?

Riggs said focusing on optimizing your health before pregnancy to decrease your risk factors can go a long way toward reducing the possibility of having a high-risk pregnancy.

“If you have a history of high-risk pregnancy or complicated delivery, talk with your provider before conceiving,” she said. “We know substances such as alcohol and drugs can cause problems in pregnancy, and when it comes to marijuana we’re seeing more emerging evidence that links its use to an increased risk for learning disabilities and attention problems in children. If you suffer from substance abuse, stop using before pregnancy and ask for help if you need it.”

Riggs emphasized that women should speak with their provider about any concerns they have.

“We’re here to help you prepare for this journey and get yourself in a good place before adding the extra stress and responsibility of pregnancy,” she said. “At LMH Health, our focus is on healthy families. Our most important goal is to make sure you and your baby have the best care.”

— Autumn Bishop is the marketing communications manager at LMH Health, which is a major sponsor of the Journal-World’s Health section.