Being told you have a "higher-risk pregnancy" can sound frightening; what it means is this: this pregnancy will be watched more closely. What guidelines emphasise is that risk is not a label attached once and left, but an assessment renewed at every examination.
What makes a pregnancy higher risk
Conditions arising from the mother
Conditions present before pregnancy:
- Long-term kidney disease, long-term high blood pressure and complex heart disease
- Conditions in which the immune system attacks the body's own tissue (such as lupus)
- Diabetes — present before pregnancy or appearing during it
- Blood disorders (sickle cell anaemia, thalassaemia)
- Thyroid disease
- Polycystic ovary syndrome — it increases the risk of pre-eclampsia, gestational diabetes, miscarriage and growth restriction in the baby (see Polycystic Ovary Syndrome)
Conditions carried over from previous pregnancies:
- Having previously given birth to a baby small for its gestational age
- Having previously had pre-eclampsia or high blood pressure in pregnancy
- A previous loss of a baby or a history of recurrent miscarriage
- A previous premature birth or weakness of the cervix
Conditions arising in this pregnancy:
- Pre-eclampsia and high blood pressure starting in pregnancy
- A disturbance of bile flow in the liver due to pregnancy
- Bleeding — situations such as early separation of the placenta
- Severe infection
- Excessive vomiting — it causes loss of fluid and increases the risk of a clot 2.5-fold
Other factors: excess weight, a mother's age of 40 and over and smoking.
Conditions arising from the baby
- Growth restriction — the baby staying smaller than expected or the rate of growth slowing markedly
- Twins sharing a single placenta — they carry particular risks because the vessels of the placenta are shared
- Structural or chromosomal differences found on ultrasound
- Blood group incompatibility — the risk of the mother's antibodies causing anaemia in the baby
- A reduction in the baby's movements
Take a reduction in the baby's movements seriously. The sources describe it as one of the most important warning signs that the placenta is not working well enough and that the baby is under strain. If you notice a reduction in movements, do not wait — tell your health service.
How does the follow-up change?
Monitoring growth
- If the risk is low, growth can be followed at the examination by measuring over the abdomen.
- But if there is excess weight or a fibroid in the womb, this measurement is not reliable, so follow-up is done directly by ultrasound.
- At moderate risk: a growth ultrasound every 4 weeks from week 32.
- At high risk: the follow-up becomes more frequent — every 2–4 weeks from weeks 24–28.
Blood flow (Doppler) studies
Doppler assesses the blood flow going to and returning from the baby. Different vessels are looked at for different questions:
- The uterine arteries: to determine the risk of pre-eclampsia and placental insufficiency, at the same time as the detailed ultrasound.
- The umbilical cord artery: shows whether the placenta is working well enough; it is the basic tool for telling whether the baby is "small but healthy" or genuinely under strain.
- The vessels of the brain: show the baby's effort to protect its oxygen supply.
- In blood group incompatibility, the level of anaemia in the baby can be followed with Doppler without an invasive procedure.
The baby's heart trace
A heart trace assessed by eye can be interpreted differently by different people. For this reason computerised assessment is used in higher-risk monitoring; this method measures numerically the fine changes that cannot be seen by eye and contributes to the decision on the timing of birth.
Measures taken for the mother
- Preventing pre-eclampsia: those at high risk are started on low-dose aspirin in the evening from week 12, continued until week 36.
- Distinguishing with a blood test: when pre-eclampsia is suspected, a particular blood test can be used to avoid unnecessary delivery and admission.
- Close monitoring: in higher-risk pregnant women admitted to hospital, breathing, blood pressure, pulse, temperature and oxygen level are monitored hourly.
Where should care take place?
Some situations — particularly growth restriction starting before week 32 and problems in twins sharing a single placenta — require several specialties to work together.
It is recommended that these pregnancies be managed by a team of an obstetrician, a fetal medicine specialist, a neonatal specialist and an anaesthetist, in centres with advanced neonatal intensive care.
Frequently Asked Questions
What does being told I have a "higher-risk pregnancy" mean?
It means the pregnancy will be watched more closely. An important point: the level of risk is not fixed — it can change through the pregnancy and, according to the guidelines, is reassessed at every examination. It is not a label attached once and left.
My baby's movements have reduced — can I wait?
No, do not wait. The sources describe a reduction in the baby's movements as one of the most important warning signs that the placenta is not working well enough and that the baby is under strain. Tell your health service as soon as you notice it.
How often will I have an ultrasound?
It depends on the level of risk. At moderate risk, a growth ultrasound every 4 weeks from week 32; at high risk, every 2–4 weeks from weeks 24–28. If there is excess weight or a fibroid in the womb, the measurement over the abdomen is not reliable, so follow-up is done directly by ultrasound.
Why is Doppler done?
To assess the blood flow going to and returning from the baby. Different vessels are looked at for different questions: the uterine arteries for the risk of pre-eclampsia, the umbilical cord artery for how the placenta is working — this is the basic tool for telling whether the baby is "small but healthy" or genuinely under strain.
I have been given aspirin — why?
Those at high risk of pre-eclampsia are started on low-dose aspirin in the evening from week 12, continued until week 36. This is a preventive measure. Your doctor decides the dose and how it is used.
I have polycystic ovary syndrome — is my pregnancy considered higher risk?
PCOS is among the conditions that increase the risk of pre-eclampsia, gestational diabetes, miscarriage and growth restriction in the baby during pregnancy. This does not mean you will have problems — it means you will be watched more closely. When planning a pregnancy, measuring blood pressure and a glucose tolerance test are recommended.
I am expecting twins — is every twin pregnancy higher risk?
Twins sharing a single placenta in particular carry special risks, because the vessels of the placenta are shared. This can lead to problems with blood being shared between the twins. These pregnancies should be followed by a multi-specialty team and in centres with advanced neonatal intensive care.
Where should I give birth?
Some situations require several specialties to work together — particularly growth restriction starting before week 32 and problems in twins sharing a single placenta. It is recommended that these pregnancies be managed by a team of obstetric, fetal medicine, neonatal and anaesthetic specialists, in centres with advanced neonatal intensive care.
Sources
- RCOG Green-top Guideline — Investigation and Care of a Small-for-Gestational-Age Fetus and a Growth Restricted Fetus. Intervals for growth monitoring, Doppler studies and the timing of birth.
- ISUOG Practice Guidelines — the diagnosis and management of fetal growth restriction; the role of ultrasound in multiple pregnancy.
- RCOG Green-top Guideline — Management of Monochorionic Twin Pregnancy (2024 update).
- RCOG guidelines — obesity in pregnancy, severe nausea and vomiting, obstetric cholestasis, maternal sepsis and the assessment of reduced fetal movements.
- Guideline on blood group incompatibility and the management of red cell antibodies in pregnancy.
The information on this page is based on the national and international guidelines listed above. The page is reviewed whenever those guidelines are updated.
Practice and Contact Details
The information on this page is general. Please speak to your doctor about your own situation.
- DoctorOp. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology
- AddressOp. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya
- Telephone0505 351 77 88
- HoursMonday – Saturday 09:00 – 18:00 · Closed on Sunday