Pregnancy

Most pregnancies are considered "low-risk," which describes healthy pregnancies that proceed in a routine way; this is one time in your life when being ordinary is good. Pregnancies are considered "high-risk" if either the mother or baby has a health concern or another issue that makes the pregnancy or delivery riskier than an ordinary pregnancy.

Who is high-risk? A pregnancy is high-risk if the mother had a preexisting medical disorder such as diabetes or lupus; if she develops a complication during pregnancy such as early preeclampsia or placenta previa; if the baby is believed to have a birth defect or other problem; if the mother is obese; or if there is more than one baby. In some cases, women who have conceived through in vitro fertilization or other assisted reproduction techniques are considered to be high-risk during pregnancy. Some doctors consider any pregnancy in a mother over age 40 to be high-risk. Not all doctors subscribe to this belief, however. Some feel that maternal health and fitness matter more than age. With these doctors, if you are a healthy, fit 42-year-old, your pregnancy will be considered lower-risk than the pregnancy of an unhealthy, unfit woman who is much younger.

Precautions. If your pregnancy is high-risk, you may be monitored differently, with more frequent doctor visits or tests, depending on the reason for the concern. In some cases, you doctor may recommend that you stop exercising, change your diet, or decrease your activity for the remainder of your pregnancy in order to reduce the risk of harm to you or your baby.

Your doctor may refer you to a high-risk obstetrician, or you may choose to see one on your own. High-risk obstetricians (also called perinatologists) are specialists who are trained to manage the complications that a high-risk pregnancy can bring. Your doctor may also recommend that you give birth in a hospital, such as a university-affiliated teaching hospital or a hospital with a neonatal intensive care unit that is fully equipped to provide state-of-the-art care for you and your baby.

Where you live enters into these decisions. You have more choices of specialists and hospitals if you live in New York City or Boston than you would have in a small town that is hundreds of miles from a major city. Again, the nature of your complication may determine your course of action. If you're having twins and everything seems normal, you and your doctor may feel comfortable having you give birth in a community hospital. However, if you're having triplets and you started the pregnancy with uncontrolled high blood pressure, it makes sense to see a perinatologist and deliver in a hospital that is well prepared for potentially difficult deliveries.