High-Risk Pregnancy: Understanding Management, Factors, and Care

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer

A high-risk pregnancy is any pregnancy with a higher-than-average chance of complications for the pregnant person or the baby [1]. It does not mean problems will happen, but it does mean extra medical attention and monitoring for the safest possible outcome. Approximately 30,000 to 50,000 pregnant people in the U.S. each year, between 6% and 8%, have a high-risk pregnancy [1].

What the research says

• "High risk" is a working label, not a prediction. A nursing review explains that there is no exact definition of risk in pregnancy, because the pregnant person and the provider may perceive risk differently. People with complicated pregnancies may need lifestyle changes, medication plans, technical support, and sometimes hospitalization (Holness, Nursing Clinics of North America, 2018) [2].

• Preexisting conditions such as lupus carry specific risks, which is why planning with specialists matters. In a meta-analysis of 53 studies covering 33,694 pregnancies in women with lupus, 3.29% of babies had structural heart malformations and 1.29% had congenital heart block. Compared with healthy controls, the odds of structural malformations were higher (odds ratio 3.52, 95% CI 2.13 to 5.81), and the link stayed significant in five studies that adjusted for other factors (odds ratio 1.70). Active lupus was associated with more malformations (Fang et al., Immunologic Research, 2026) [3].

• Most complications resolve at delivery, but they can signal future health risks. A review reports that people who had complications such as preterm labor, placental abruption, preeclampsia, or gestational diabetes are at higher risk of similar problems in later pregnancies, and of cardiovascular and metabolic disease later in life (Neiger, Journal of Clinical Medicine, 2017) [4].

Key Takeaways

The Nature of High-Risk Pregnancy

All pregnancies carry some risk [1]. A "high-risk" label means that specific factors raise the chance of complications. It is a tool providers use to trigger closer monitoring and protective measures, not a prediction that something will go wrong. Many people have a healthy pregnancy and normal labor and delivery despite needing extra care along the way [1].

Why a Pregnancy Becomes High Risk

Some pregnancies begin as high risk, while others become high risk at some point during the pregnancy [1]. Identifying risks early lets your team give the support needed to reduce problems before they become severe.

Factors Contributing to High Risk

Three broad categories of factors can lead to a high-risk classification: health conditions you had before pregnancy, conditions that develop during pregnancy, and lifestyle factors [1].

Preexisting Health Conditions

• Autoimmune diseases: Such as lupus or multiple sclerosis [1].

• Chronic illnesses: Including diabetes, high blood pressure, and kidney disease [1].

• Reproductive and hormonal conditions: Such as uterine fibroids, polycystic ovary syndrome (PCOS), and thyroid disease [1].

• Other conditions: Obesity, HIV/AIDS, mental health disorders such as depression, and blood clotting disorders [1].

Pregnancy-Related Conditions

• Gestational diabetes [1]: High blood sugar that develops during pregnancy.

• Hypertension disorders: Gestational hypertension, preeclampsia, and eclampsia [1].

• Multiple gestation: Carrying twins, triplets, or more [1].

• Placental conditions: Such as placenta previa or placental abruption [1].

• Amniotic fluid problems: Too much or too little amniotic fluid [1].

• Previous problems: A previous preterm birth or other complications in earlier pregnancies [1].

• Low birth weight [1]: A baby who is smaller than expected.

Lifestyle and Age Factors

• Lifestyle: Smoking, substance use disorder, alcohol use disorder, and exposure to certain toxins [1].

• Age: Being over 35 or under 17 when pregnant can make a pregnancy high risk, but age alone does not decide it [1]. Your provider looks at several other factors too.

Recognizing Warning Signs

Contact your pregnancy care provider right away if you notice any of these symptoms [1], whether your pregnancy is high risk or low risk.

Pregnancy-related complications can occur up to six weeks after a pregnancy ends [1], so keep paying attention to your health after delivery and tell your provider right away if anything seems abnormal.

Diagnosis and Specialized Monitoring

Getting early and thorough prenatal care as soon as you know you are pregnant [1] is the best way to detect and manage a high-risk pregnancy. Tell your provider about your health history and any past pregnancies [1].

Essential Tests

• Ultrasound: People with high-risk pregnancies usually have more frequent ultrasounds [1] to check how the baby is developing. A low-risk pregnancy typically has two to three, and you will likely have more than three [1].

• Blood and urine tests: To check your health and the baby's risk for genetic conditions [1].

• Fetal monitoring: A nonstress test (NST) and a biophysical profile (BPP) check on the overall health of the baby and the placenta [1].

The Care Team

You may work with a team that includes:

1. Obstetrician: Provides your main pregnancy care.

2. Maternal-fetal medicine (MFM) specialist: A specialist in high-risk pregnancy.

3. Other medical specialists: Such as a rheumatologist or endocrinologist, depending on your health conditions.

4. Psychologists and genetic counselors [1]: To support your emotional well-being and help you understand genetic risks.

Management and Treatment Strategies

Care is individualized to your specific risks.

Care Plans

• Closer monitoring: More prenatal visits and imaging, and consultation with an MFM specialist [1].

• Home monitoring: Such as checking your blood pressure at home [1].

• Medication management: Careful monitoring of medicines used for preexisting conditions [1], so they are safe for the baby.

• Earlier delivery: If there are signs that the pregnancy is in danger, your provider may recommend labor induction or a cesarean delivery earlier than planned [1].

Outlook and Future Health

Many people with high-risk pregnancies have no problems and deliver healthy babies [1], but there can be higher risks for later health [1].

Possible Future Risks for the Parent

• Complications in future pregnancies [1] [4].

• Postpartum depression [1].

• High blood pressure, cardiovascular disease, type 2 diabetes, and stroke [1].

Possible Risks for the Child

Some high-risk pregnancies can raise the child's risk of:

• Behavioral problems and mental health conditions [1].

• Respiratory conditions and gastrointestinal diseases [1].

• Growth and developmental delays and neurological disorders [1].

• Obesity and diabetes [1].

• Vision, hearing, or dental problems [1].

A high-risk pregnancy does not mean you or your baby will have any of these problems. Talk to your provider about your own risks.

Staying Positive During a High-Risk Pregnancy

Learning that your pregnancy is high risk can bring anxiety and worry. Trust your care team, ask questions, and try these steps:

• Build a support system: Lean on family, friends, or support groups [1].

• Focus on healthy habits: Get enough sleep, move a little each day, and eat nutritious foods [1].

• Prioritize self-care: Practice relaxation techniques such as meditation [1] and do things you enjoy every day.

Going to all of your prenatal appointments and imaging tests is one of the best things you can do to give a high-risk pregnancy a good outcome.

Conclusion

A high-risk pregnancy needs extra vigilance and specialized care, but it is manageable and most often ends well. By following your team's recommendations, attending every appointment, and keeping up healthy habits, you can lower your chance of complications and give your baby a healthy start.

Frequently Asked Questions

What makes a pregnancy high risk?

Preexisting health conditions, conditions that develop during pregnancy, lifestyle factors such as smoking or alcohol, and in some cases age can all play a role [1].

Does a high-risk pregnancy mean I will need a C-section?

Not necessarily, although a cesarean delivery may be more likely depending on your specific risk factors [1].

Can I still exercise during a high-risk pregnancy?

Many people can [1], but ask your provider which activities are safe for you.

How many extra ultrasounds will I need?

It varies. Low-risk pregnancies typically have two to three, and with a high-risk pregnancy you will likely have more than three [1]. Your provider will tell you how many to expect.

Is bed rest always required for high-risk pregnancies?

No. Bed rest is no longer routinely recommended for most high-risk conditions, although your provider may limit some activity. Follow your provider's advice.

Can stress cause a pregnancy to become high risk?

Stress is not a listed cause by itself, but it can worsen conditions such as high blood pressure. Talk to your provider about ways to manage it.

What is a maternal-fetal medicine (MFM) specialist?

An obstetrician with additional training in pregnancy complications. This specialist is also called a perinatologist.

Are all pregnancies after age 35 high risk?

Not automatically. Age alone does not decide it [1], and your provider looks at several other factors.

Can high-risk status change during pregnancy?

Yes. Some pregnancies become high risk later [1], and your provider will keep reassessing your risk as the pregnancy goes on.

Does gestational diabetes make a pregnancy high risk?

It is one of the pregnancy-related conditions that can make a pregnancy high risk [1], and it needs close monitoring of your blood sugar.

What is preeclampsia?

A serious blood pressure condition that can develop after the 20th week of pregnancy.

Can I still work if my pregnancy is high risk?

Most people can work, go to school, and continue their usual routines [1]. Discuss your work arrangements with your provider.

Is a twin pregnancy high risk?

Multiple gestation is one of the conditions that can make a pregnancy high risk [1], because carrying more than one baby can raise the chance of preterm labor and other complications. Your provider will tell you how closely to monitor.

What are the signs of preterm labor?

Severe pelvic pain, cramping or regular contractions, vaginal bleeding, or leaking fluid. Contact your provider right away, especially before 37 weeks.

How does obesity affect pregnancy risk?

It can raise the chance of complications such as gestational diabetes and preeclampsia. Ask your provider how to plan for a healthy pregnancy.

Can I fly during a high-risk pregnancy?

It depends on your specific risks and how far along you are, so check with your provider first.

What is placental abruption?

A condition in which the placenta separates from the inner wall of the uterus before birth.

Does a previous pregnancy complication make my current pregnancy high risk?

It can. A previous preterm birth or other complications in earlier pregnancies are recognized factors [1].

What is a nonstress test (NST)?

A test that records the baby's heart rate, usually in response to the baby's own movements.

How does smoking affect a high-risk pregnancy?

Smoking is a lifestyle factor that can raise the chance of complications [1]. Ask your provider for help quitting.

What is eclampsia?

A severe complication of preeclampsia characterized by seizures.

Can thyroid disease affect the baby?

Unmanaged thyroid problems can affect the pregnancy, so your provider will monitor and manage them.

What is placenta previa?

A condition in which the placenta covers the opening of the cervix.

Does high-risk status affect where I can give birth?

Your care team may recommend a hospital with a high-level neonatal intensive care unit (NICU). Discuss your delivery plan with them.

Can I prevent a high-risk pregnancy?

You can reduce risk by identifying health risks before pregnancy, managing existing conditions, keeping a healthy weight, avoiding alcohol and nonprescription drugs, quitting smoking, and making sure long-term medicines are safe [1]. Some risks cannot be avoided.

What is a biophysical profile (BPP)?

An ultrasound-based test that evaluates the baby's breathing, movement, muscle tone, and amniotic fluid.

How often will I see my doctor?

More often than in a typical pregnancy. Your care team will set the schedule based on your risk factors.

Does a high-risk pregnancy affect the baby's long-term health?

Most babies are fine, but some high-risk pregnancies can raise the child's risk of problems such as respiratory conditions or developmental delays [1].

What is gestational hypertension?

High blood pressure that begins after 20 weeks of pregnancy in a person who previously had normal blood pressure.

Can autoimmune diseases change during pregnancy?

Yes. They can, which is why your obstetrician and your specialist should work together.

What is "low birth weight"?

When a baby weighs less than 5 pounds, 8 ounces at birth.

Can I take my regular medicines?

Some need to change, so never stop a medicine without talking to your provider, and make sure long-term medicines are safe in pregnancy [1].

What is stillbirth?

The loss of a baby after 20 weeks of pregnancy.

How common is preeclampsia?

It is one of the more common pregnancy complications. Ask your provider about your own risk.

Does a high-risk pregnancy cause postpartum depression?

It does not cause it, but a high-risk pregnancy can raise the risk of postpartum depression [1], so tell your provider how you are feeling.

What is amniotic fluid?

The fluid that surrounds and protects the baby in the uterus.

Can kidney disease cause complications?

Yes. It is a preexisting condition that can make a pregnancy high risk [1], including a higher risk of preeclampsia and preterm birth.

What is labor induction?

Using medicines or other methods to start labor before it begins on its own.

Are teenagers at higher risk?

Being under 17 can make a pregnancy high risk [1], depending on other factors.

What is a congenital condition?

A health problem present at birth, often called a birth defect.

Can I have a natural birth with a high-risk pregnancy?

In many cases, yes, if you and the baby stay stable during labor. Your team will advise you.

What is the NICU?

The neonatal intensive care unit, which cares for sick or premature newborns.

Does IVF make a pregnancy high risk?

It may be monitored more closely, particularly if more than one baby is expected. Ask your provider how it affects your care.

What is oligohydramnios?

Too little amniotic fluid around the baby.

How does alcohol affect the baby?

Alcohol use during pregnancy can cause fetal alcohol spectrum disorders and lifelong developmental problems, so avoid alcohol.

What is excessive bleeding after birth?

Postpartum hemorrhage, which is a risk in some high-risk pregnancies [1].

How can I stay positive?

Build a support system, focus on healthy habits, practice self-care [1], and keep every prenatal appointment.

When should I call emergency services?

For chest pain or severe trouble breathing, or if you have thoughts of harming yourself, seek help right away from your local emergency services.

Does high-risk status mean my baby will go to the NICU?

Not necessarily, but your team will be prepared for that possibility.

What is the most important thing to do?

Attend all of your prenatal appointments and follow your care team's guidance.

Related Reading

External Cephalic Version (ECV): Turning a Breech Baby explains how ECV turns a breech baby.

Due Date Calculator: How Your Pregnancy Due Date Is Calculated: Our due date calculator guide explains how providers confirm a due date with ultrasound, including for twins and triplets.

Learn more in our guide to Nonstress Test (NST): Why It's Done, What to Expect and Reactive vs Nonreactive Results.

20-Week Ultrasound (Anatomy Scan): What It Checks, How to Prepare and What Results Mean explains the mid-pregnancy scan that can detect signs of this condition before birth.

References

1. Cleveland Clinic. High-Risk Pregnancy: Age, Complications & Management. Cleveland Clinic. Last updated July 12, 2024. https://my.clevelandclinic.org/health/diseases/22190-high-risk-pregnancy

2. Holness N. High-risk pregnancy. Nursing Clinics of North America. 2018;53(2):241-251. PMID 29779516. https://doi.org/10.1016/j.cnur.2018.01.010

3. Fang K, Tan L, Wu L. Maternal systemic lupus erythematosus and the risk of congenital cardiovascular abnormalities in offspring: a systematic review and meta-analysis. Immunologic Research. 2026;74(1). PMID 42714705. https://doi.org/10.1007/s12026-026-09839-2

4. Neiger R. Long-term effects of pregnancy complications on maternal health: a review. Journal of Clinical Medicine. 2017;6(8):76. PMID 28749442. https://doi.org/10.3390/jcm6080076

Disclaimer

This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.