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High-Risk Pregnancy: Ensuring a Healthy Baby

March 16, 2012 1:29 PM with Dr. Scott MacGregor

A high-risk pregnancy can involve the baby, mother or both. Common conditions include preeclampsia, gestational diabetes, premature births, placenta previa and endometrosis. Join Scott MacGregor, DO, obstetrician at NorthShore as he answers your questions about the risk factors, treatments and signs of a high-risk pregnancy. Your participation and early questions are welcomed.

Angela (Moderator) - 1:15 PM:
Welcome! Today’s chat: High-Risk Pregnancy – Ensuring a Healthy Baby will begin shortly. Please start submitting your questions and Scott MacGregor, DO, will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the, Maternity Services pages on our website. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

  jeanna (phoenix) - 1:32 PM:
Should I be worried about trying to get pregnant for the first time at 36/37 years old? What are the risks?
Dr. Scott MacGregor (NorthShore)
There are slightly greater risks. The chances of having difficulty conceiving are greater but most women your age are able to get pregnant. The risk of having a baby with a chromosomal abnormality is greater as you get older, but the risk at your age is still less than 1 in 150 pregnancies. Genetic screening and testing are available to you. There is also a slightly greater risk of hypertension and diabetes in pregnancy. Having said all of that, I would still be very optimistic about your pregnancy. Almost all women your age do well and delivery healthy babies.

  Kelly (Chicago, IL) - 1:36 PM:
Even before becoming pregnant, I’ve had high blood pressure. I’m 18 weeks along and so far have been relatively stable with my blood pressure. What are some of the symptoms of preeclampsia? Is there any I can to prevent it from occurring?
Dr. Scott MacGregor (NorthShore)
Preeclampsia is very uncommon before 26 weeks. Symptoms can include edema, which is very common in all pregnancies. Other symptoms could include severe headache, epigastric pain and sudden swelling of the hands and face. The best advice would be to check your BP at home and see your doctor frequently in the 3rd trimester.

  Amanda (Evanston, IL) - 1:39 PM:
What causes preterm labor? If I’ve miscarried before (at 10 weeks), am I at a greater risk of having a preterm birth now?
Dr. Scott MacGregor (NorthShore)
Preterm labor can occur in patient with a prior history of preterm delivery, uterine malformations, large uterine fibroids and others, but most patients have no risk factors. Prior miscarriage at 10 weeks would not be a risk factor for preterm delivery in a future pregnancy.

  Maggie (Schaumburg, IL) - 1:42 PM:
What importance does your blood type have to do with pregnancy? I am pretty sure that I have Rh negative blood and my husband is Rh positive. Is this something I need to be concerned with?
Dr. Scott MacGregor (NorthShore)
Not really today and this is not uncommon. You would receive a shot of Rhogam during the pregnancy and after delivery to prevent you from having problems in future pregnancies.

  Kate (Evanston, IL) - 1:44 PM:
I have a family history of diabetes and gestational diabetes. I am 21 weeks pregnant and am wondering what tests are done to determine if I have it? Is there anything I can be doing now to help reduce my risk?
Dr. Scott MacGregor (NorthShore)
Your risk is slightly greater than the 3-5% risk in the general population. Being overweight would also be a risk factor. Generally, screening for gestational diabetes is performed in all pregnancies at 26-28 weeks. You can eat healthy and avoid excessive non-complex carbs. Otherwise, there's not much any of us can do about our family histories.

  Julie (Chicago, IL) - 1:47 PM:
What is the difference between just having high blood pressure and preeclampsia? What are some of the treatment options? Will they go away after giving birth?
Dr. Scott MacGregor (NorthShore)
If a patient has onset of high BP before 20 weeks, it is most likely underlying high blood pressure and not preeclampsia. Preeclampsia is high BP with protein in the urine and usually associated with edema. It is uncommon to see preeclampsia before 26 weeks. If a person has preeclampsia, it usually goes away after delivery but may take up to 4-6 weeks.

  Jane (Highland Park, IL) - 1:51 PM:
My husband and I had been trying to conceive for months. We were thrilled to learn that I was finally pregnant, but later found out it was an ectopic pregnancy. After an extremely difficult miscarriage and emotional time, we’re wondering if we have an increased risk of miscarriage in the future. Do you have any recommendations to ensure a healthy pregnancy next time?
Dr. Scott MacGregor (NorthShore)
Patients with ectopic pregnancies are at increased risk for future ectopics, but most will conceive and the pregnancy will be in the uterus. If your pregnany is in the uterus, which is most probable in the future, you are not at increased risk for miscarriage because you had a prior ectopic. Your physician could consider doing a test to assess the tubes and make sure there are not abnormalities which would predispose you to an ectopic pregnancy.

  B.D. (skokie) - 1:55 PM:
I’ve suffered from endometriosis for years. My partner and I are trying to conceive. What expectations should we have? I know that my fertility is affected by my condition, but I am wondering if there are any specific things we should try to increase our chances of pregnancy?
Dr. Scott MacGregor (NorthShore)
Most people with endometriosis are able to conceive on their own, but there is a slightly greater risk of infertility. If you conceive, I would not anticipate a more complicated pregnancy. If you are having difficulty conceiving, I would suggest discussing your situation with you doctor and consider seeing an infertility specialist.

  Fran (Chicago, IL) - 1:58 PM:
What constitutes a high-risk pregnancy? Is there anything that can be done in advance to reduce complications?
Dr. Scott MacGregor (NorthShore)
There are many high risk factors during pregnancy, but most patients with these risk factors do well during pregnancy. I would recommend discussing you specific history with your physician to see if you have any factors that should prompt management or consultation before conceiving.

  Louise (Chicago, IL) - 2:01 PM:
My doctor told me I am at risk of placenta previa. What is this and what risks does it have for me and my baby?
Dr. Scott MacGregor (NorthShore)
Placenta previa is a condition in which the placenta covers the cervix and will require cesarean delivery. Most will deliver near term but there is a greater risk of bleeding and needing hospitalization during pregnancy. I would suspect that you were told this because you have a placenta that is near the cervix. Most cases of low lying placenta resolve. Only 1% of pregnancies are placenta previa at delivery.

  Emily (Glenview) - 2:05 PM:
At my last prenatal appointment I was told everything looks fine. Having had two miscarriages previously, I cannot help to be worried or nervous about this pregnancy. Are there certain warning signs and symptoms that I should be aware of if something is going wrong? When it is absolutely necessary to call my doctor or go to the hospital?
Dr. Scott MacGregor (NorthShore)
20% of pregnancies end in miscarriage, but most occur early in pregnancy. If there is still a heart beat present at 9-10 weeks, the risk of miscarriage is < 3%. You can always call your doctor with a question, but it sounds as if your pregnancy is going well.

  Val (Chicago, IL) - 2:08 PM:
Is it more common to have a C-section with a high-risk pregnancy? How will I know if this is the best option for me for delivery?
Dr. Scott MacGregor (NorthShore)
It can be more common, but it would depend on the circumstances. Most high-risk pregnancies can deliver vaginally, which is a safe option for both mother and baby.

  Kathryn (Evanston IL) - 2:12 PM:
When is a Braxton-Hicks contraction actually preterm labor?
Dr. Scott MacGregor (NorthShore)
Contractions are common throughout pregnancy. I generally tell patients that if the contractions are less than 4-6 per hour, you can generally ignore them. If they are greater than 4-6 per hour, you should get off of your feet and drink fluids. If they persist at this frequency, you should call your doctor.

  Victoria (Oak Park) - 2:15 PM:
If I had eclampsia in my first pregnancy, am I at a greater risk in my next pregnancy?
Dr. Scott MacGregor (NorthShore)
Your risk of recurrence of preeclampsia or eclampsia is 30-35%. However, that would also mean that it is 65-70% likely that you will not have a recurrence.

  Jolene (Chicago, IL) - 2:18 PM:
Is it true that intercourse and orgasm can lead to premature labor?
Dr. Scott MacGregor (NorthShore)
There's not any good information suggesting that intercourse or orgasm can cause preterm labor. They can be associated with contractions, but not preterm labor.

Angela (Moderator) - 2:21 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.

  Aimee (Evanston) - 2:22 PM:
Can you recommend any resources or support groups for women with high-risk pregnancies in the area? It would be helpful for me to be able to talk with and meet other women going through the same thing as me.
Dr. Scott MacGregor (NorthShore)
There are many support groups and other resources through the Perinatal Family Support Center. You can reach them at 847.570.2880.

  Alison (Highland Park) - 2:25 PM:
I almost through my first trimester and have had continual cramping. While I’ve had some spotting, I’ve mostly had mild to severe cramps. At what point is cramping abnormal and a cause for concern? Should this cramping lessen in my second trimester?
Dr. Scott MacGregor (NorthShore)
Cramping is not uncommon and can persist throughout pregnancy. If the spotting resolves, the cramping is not usually worrisome.

  Liz (Skokie) - 2:28 PM:
What high-risk pregnancy issue is most common? How much does healthy diet and lifestyle impact your chances of being at risk?
Dr. Scott MacGregor (NorthShore)
Some of the most common issues are high blood pressure, diabetes and prior history of preterm delivery. Healthy diet and lifestyle are important for the best pregnancy outcome. However, complications can occur in pregnancies despite healthy diet and lifestyle.

Angela (Moderator) - 2:30 PM:
Thank you for participating in our online chat today. An online transcript will be available shortly. To learn more about High-Risk Pregnancy, read our recent blog post.

This chat has ended.

Thank you very much for your participation.