High-Risk Pregnancy in Dubai

“High-risk” describes a level of care, not a prediction

Doctors call a pregnancy high-risk when something raises the chance of a complication for the mother or the baby. It is a wide term. It covers a woman whose underactive thyroid is well controlled on treatment and a woman expecting triplets, and the care each needs is different.

The label does not mean that something will go wrong. It means the pregnancy is followed more closely, with shorter gaps between checks, so that any change can be noticed early and dealt with in good time.

Many women who read about this are worried. That is a normal response, and closer care exists partly to meet that worry with clear information about what is being watched and why.

Risk is assessed at the early antenatal visit and reviewed at every visit after that, because a pregnancy changes over time.

Common reasons a pregnancy needs closer care

Some reasons are known before a pregnancy begins. Others appear along the way. The most common are:

• A condition you already live with, such as high blood pressure, diabetes, a thyroid condition, heart disease or kidney disease.
• A condition that develops during pregnancy, such as pre-eclampsia (raised blood pressure after 20 weeks with signs that it is affecting the kidneys, liver or placenta) or gestational diabetes, which is diabetes that begins in pregnancy.
• Expecting twins, triplets or more.
• A complication in a previous pregnancy, such as pre-eclampsia, a baby born early or small, heavy bleeding after the birth, or a previous cesarean birth.
• Age, for example being 40 or older, which raises the chance of some complications such as pre-eclampsia.

Other factors are weighed too, including body weight and whether your mother or sister had pre-eclampsia. Often it is a combination rather than a single factor, and two women with the same condition may need different levels of care, depending on how settled the condition is and how the pregnancy is progressing.

What closer monitoring usually involves

The plan depends on the reason, but most closer care is built from the same parts:

• More antenatal checks, with shorter gaps between them than in routine care.
• Blood pressure and a urine test for protein at every check, since a rise in either can be an early sign of pre-eclampsia.
• Growth scans, which measure the baby and the fluid around the baby and show whether growth is following the expected pattern.
• Blood sugar monitoring where diabetes is part of the picture, usually with a home meter several times a day, and the readings reviewed at each visit.
• For twins, extra scans from early pregnancy. An early scan shows whether the babies share a placenta, and twins who share one are scanned more often.
• Working with other specialists, such as a physician for blood pressure or diabetes, a cardiologist, a kidney specialist, an anaesthetist and the neonatal team who care for newborn babies.

Medicines are part of this too. Some are changed before or early in pregnancy because certain types are not recommended while pregnant, and some are added. For example, NICE advises low-dose aspirin from 12 weeks until the birth for women with certain risk factors for pre-eclampsia. It is started on medical advice, not on your own.

It is reasonable to ask at each visit what a check is looking for and what it showed. Knowing why a test is done makes the plan easier to follow, and makes it clearer which changes matter between visits.

If you take a regular medicine and find you are pregnant, do not stop it on your own. Some medicines need changing in pregnancy, and stopping others suddenly can cause harm. Ask the doctor who prescribes it to review it as soon as you can.

Planning the timing and way of birth together

When and how the baby is born is discussed as the pregnancy progresses, not settled at the start. The plan takes into account the reason for closer care, how the baby is growing, the baby’s position, your previous births and what matters to you.

For some conditions, guidelines advise that the baby is born a little before the due date, for example with diabetes that began before pregnancy, pre-eclampsia or twins. That can mean starting labour with medical help (induction) or a planned cesarean. Many women whose pregnancy was called high-risk still have a vaginal birth.

Where the birth happens matters too. For many of these conditions, NICE advises giving birth in a hospital with a labour ward, an anaesthetist and a neonatal unit, so that help is close if it is needed.

Closer monitoring helps changes get noticed early, which gives more time to act. It cannot remove all uncertainty. Every pregnancy carries some, and a plan may need to change at short notice. Knowing in advance what would change the plan can make a sudden change easier to face.

Preparing before pregnancy when you have a known condition

If you live with a long-term condition, a review before you try to conceive gives time to prepare. The aim is to begin the pregnancy with the condition as settled as it can be, on medicines suited to pregnancy.

With diabetes, NICE advises aiming for steady blood sugar before conceiving, a higher dose of folic acid than usual, and checks of the eyes and kidneys, since pregnancy can affect both. Women with diabetes are usually advised to keep using contraception until their blood sugar is well controlled.

With high blood pressure, some medicines are switched before or soon after conception, because certain types are not recommended in pregnancy. With a thyroid condition, hormone levels are checked and the dose often needs adjusting early in pregnancy. With heart or kidney disease, the specialist who knows your condition can explain what pregnancy may mean for it, and what it may mean for the pregnancy.

After a pregnancy with complications, a calm conversation about what happened, and what it might mean next time, can help before trying again.