Amanda Wilde (Host): Pregnancy is a natural process, but some pregnancies have a high potential for health complications. We'll talk about how to identify and manage high-risk pregnancies with Dr. Hartaj Powell, Medical Director, Department of Obstetrics and Gynecology Holy Cross Health.

Host: This is your Best Life Podcast, Women's Health from Holy Cross Health. I'm Amanda Wilde. Dr. Powell, thank you for being here today.

Hartaj Powell, MD: Thank you so much for having me.

Host: Now, what classifies a pregnancy as high-risk?

Hartaj Powell, MD: It would be nice if it was a black and white answer. But it's actually more complicated, because there are two patients. There's the mom and the baby. So, any medical condition that affects the mom could deem her as a high-risk pregnancy or a condition that affects the baby could deem the pregnancy as a high-risk pregnancy. So, any medical condition that is preexisting to the pregnancy or is acquired during the pregnancy.

Host: So, how are these high-risk pregnancies diagnosed?

Hartaj Powell, MD: Well, they can be diagnosed prior to pregnancy. So if someone has high blood pressure or diabetes, obviously that you will know prior to getting pregnant, and puts you at a pregnancy class of higher risk. And then, there are conditions that can develop during the pregnancy. So, that is why establishing care with your obstetrician is important, because at those visits we are sort of screening and looking for signs of any conditions that would put you into that high-risk classification.

Host: Well, that actually leads me to my next question. What happens at those high-risk pregnancy appointments?

Hartaj Powell, MD: So at those high-risk pregnancy appointments, you may have increased screening or blood work, lab work, whether it's increased blood pressures that we're monitoring, that you've taken at home and that we're reviewing, and potentially increased ultrasounds if it's a condition that's affecting the baby.

Host: Now, are there particular things that mothers who have high-risk pregnancies can do to take care of their health and the pregnancy?

Hartaj Powell, MD: Yes. One of the most important things is establishing care prior to conceiving, so that you can optimize your own health without concerning for the baby. If you're considering becoming pregnant or starting a family or having another one make sure that you are seeing a primary care doctor, seeing an obstetrician-gynecologist, so that you maximize your health prior to becoming pregnant. And then of course, when you are pregnant, to establish prenatal care as early as possible so that we can do the screening. And you can discuss with your obstetrician a healthy diet and exercise plan for example. Starting prenatal vitamins is also an easy thing to start that you can do on your own.

Host: So, establishing care is really key to identifying if you have a high-risk pregnancy and just talking with your doctor about your individual situation and the pregnancy. What should someone with high-risk pregnancy expect during labor and delivery that might be different from a non-high risk pregnancy?

Hartaj Powell, MD: This may include increased monitoring, like I said before, even in not just antipartum or prior to delivery, but during labor and delivery, you might be more closely monitored, whether it's increased blood work, increased blood pressure checks, or you might be at higher risk of complications of childbirth, so afterwards, potentially increased risk of having a cesarean section or postpartum hemorrhage, something like that. But during labor and delivery, if you do have a high risk pregnancy, it's really not that much different. It just, again, might be increased surveillance.

Host: And after labor and delivery is the risk, then back to zero?

Hartaj Powell, MD: That's a great question. There are certainly conditions that once you've had them in one pregnancy, put you at increased risk of having it occur in a subsequent pregnancy, which goes back to again, it's not just having your first pregnancy that you should establish care early. It's so that you can optimize your health and review those risk factors for a subsequent pregnancy as well. There are some that, yes, it does go back down to zero. So, something that maybe affects the baby doesn't necessarily translate that it'll affect the second baby.

Host: And are there certain populations who are more prone to high-risk pregnancies?

Hartaj Powell, MD: So there are some characteristics of mom or the pregnancy that can place her at risk of having a high risk pregnancy. For example, age. if a woman is less than 21 years of age or 35 years of age or older, she could be, at a higher risk of, complications or, risk of her pregnancy, having complications.

having more than one baby. So a twin gestation or triplets, can also, have a high risk pregnancy as well as a pregnancy that's conceived through assisted reproductive technology like, in vitro fertilization or I V f pregnancies. And also weight, can place, a pregnancy in that high risk, category.

Host: So I'm hearing that being in touch with your doctor and establishing care with someone you trust is really the key to managing a high-risk pregnancy.

Hartaj Powell, MD: Absolutely. I can't stress that enough. What we train for is so that we do all of the surveillance and counseling and sort of worrying for you. So, it's to have that discussion with the professional, so that your questions are answered, your health is optimized, and we hopefully achieve the safest outcome for you and baby.

Host: Great information all around, Dr. Powell. Thank you for your insights into high-risk pregnancies.

Hartaj Powell, MD: Absolutely. Thank you so much.

Host: That was Dr. Hartaj Powell, Medical Director, Department of Obstetrics and Gynecology, Holy Cross Health. Find an OB-GYN by going to holycrosshealth.org/findadoctor. I'm Amanda Wilde. Until next time, thanks for listening and be well.