Understanding High-Risk Pregnancy: Conditions, Monitoring, and Support

Being told your pregnancy is "high risk" can feel frightening, but it simply means your care team will monitor you more closely. Many people with high-risk pregnancies go on to have healthy babies and straightforward deliveries. This guide explains what high risk means in the UK, the conditions that contribute to it, and what extra care you can expect.

What does high-risk pregnancy mean?

A high-risk pregnancy is one where there is an increased chance of complications for the pregnant person, the baby, or both. This does not mean something will definitely go wrong. It means your maternity team will offer additional monitoring, scans, and appointments to keep a closer eye on how things are progressing.

In the UK, your risk level is assessed at your booking appointment (usually between 8 and 12 weeks) and reviewed throughout pregnancy. Your midwife and obstetrician use national guidelines from NICE and RCOG to determine the level of care you need.

What conditions can make a pregnancy high risk?

Pre-existing health conditions

Some conditions that existed before pregnancy can affect how your body copes with the changes of pregnancy.

• Diabetes (type 1 or type 2). High blood sugar levels can affect the baby's development, particularly in early pregnancy. You will be offered more frequent blood sugar monitoring, additional scans, and specialist diabetes-in-pregnancy care. NICE recommends that women with diabetes aim for an HbA1c below 48 mmol/mol before conceiving.
• High blood pressure. Chronic hypertension increases the risk of pre-eclampsia, placental problems, and growth restriction. Your blood pressure will be monitored closely, and your medication may need adjusting as some blood pressure drugs are not safe in pregnancy.
• Thyroid conditions. Both overactive and underactive thyroid can affect pregnancy. Thyroid function is monitored with blood tests, and medication is adjusted as needed throughout pregnancy.
• Autoimmune conditions. Conditions such as lupus, rheumatoid arthritis, and antiphospholipid syndrome can increase risks during pregnancy. A specialist team will manage your care alongside your maternity team.
• Epilepsy. Some anti-epileptic medications carry risks during pregnancy, so medication is usually reviewed before conception. Valproate (Epilim) should not be used in pregnancy due to a high risk of birth defects.
• Mental health conditions. If you have a history of severe mental illness, bipolar disorder, or psychosis, your care plan will include perinatal mental health support. Medication changes may be needed, and this should always be done in consultation with a psychiatrist, never stopped suddenly.
• Kidney disease. Reduced kidney function can worsen during pregnancy and increase the risk of pre-eclampsia. You will have more frequent blood and urine tests.
• Heart conditions. Pregnancy places significant extra strain on the heart. If you have a heart condition, you will be cared for by a specialist cardiac-obstetric team.

Conditions that develop during pregnancy

Some complications arise for the first time during pregnancy.

• Gestational diabetes. Affects around 4 to 5% of pregnancies in the UK. It develops when your body cannot produce enough insulin to meet the increased demands of pregnancy. You will be offered a glucose tolerance test if you have risk factors. Management includes dietary changes, blood sugar monitoring, and sometimes medication.
• Pre-eclampsia. A condition involving high blood pressure and protein in your urine, usually after 20 weeks. It affects around 2 to 8% of pregnancies. Symptoms can include headaches, visual disturbances, swelling, and pain below the ribs. If untreated, it can be serious for both parent and baby. Low-dose aspirin (150mg daily from 12 weeks) is recommended for those at higher risk.
• Placenta praevia. When the placenta partially or fully covers the cervix. It is often identified at the 20-week scan and may resolve as the uterus grows. If it persists, a caesarean section will be planned.
• Obstetric cholestasis (ICP). A liver condition causing severe itching, usually in the third trimester. It requires monitoring with blood tests and may lead to earlier delivery being recommended.
• Fetal growth restriction. When the baby is not growing as expected. This may be detected through measuring your bump or at ultrasound scans. Additional monitoring may include more frequent scans and possibly earlier delivery.

Other factors that increase risk

• Age. Being under 17 or over 40 at the time of delivery is associated with higher risks of certain complications.
• BMI. A BMI over 30 or under 18.5 increases the chance of complications including gestational diabetes, pre-eclampsia, and blood clots.
• Multiple pregnancy. Carrying twins or more increases the demands on your body and the likelihood of premature birth. You will have more frequent scans and appointments.
• Previous pregnancy complications. If you had pre-eclampsia, premature birth, gestational diabetes, or stillbirth in a previous pregnancy, you will be monitored more closely this time.
• Certain infections. Some infections during pregnancy (such as cytomegalovirus, toxoplasmosis, or Group B streptococcus) require additional monitoring or treatment.

What extra care will you receive?

High-risk pregnancies are managed by a consultant-led team, meaning an obstetrician oversees your care alongside your midwife. Depending on your specific circumstances, you may have:

Additional scans

Beyond the standard 12-week dating scan and 20-week anomaly scan, you may be offered growth scans every two to four weeks to monitor the baby's development. If there are concerns about blood flow to the baby, Doppler ultrasound scans can check the blood flow in the umbilical cord.

More frequent appointments

Instead of the standard schedule of around 10 appointments for a first pregnancy, you may have appointments every one to two weeks in the third trimester, or more frequently if needed.

Specialist input

Depending on your condition, you may see specialists such as a diabetologist, cardiologist, haematologist, or perinatal mental health team alongside your maternity team. The key is that all these professionals communicate with each other to coordinate your care.

Consultant-led delivery

If your pregnancy is high risk, you will usually be advised to give birth in a hospital with an obstetric unit, where a consultant is available. This means a midwife-led unit or home birth may not be recommended, though you always have the right to make informed choices about your care.

Earlier delivery

For some conditions, your care team may recommend delivering your baby before your due date, either through induction of labour or a planned caesarean. This decision is based on balancing the risks of the condition continuing against the benefits of the baby having more time to develop. Your team will discuss the options with you.

How can you advocate for yourself?

Ask questions

You have every right to understand why a test, treatment, or recommendation is being made. If something is not clear, ask your care team to explain. Useful questions include:

• What is the specific risk to me or my baby?
• What are the alternatives?
• What happens if I choose to wait?
• What are the benefits and risks of this intervention?

Bring someone with you

Having a partner, family member, or friend at appointments can help you remember what was discussed and provide emotional support.

Keep notes

With more appointments and more information to process, writing things down can be helpful. Some people find it useful to keep a dedicated notebook or use the notes section in a pregnancy tracking app like Nuhah.

Know your rights

In the UK, you have the right to make informed decisions about your care, even if your choice differs from what is recommended. This is called informed consent. Your care team should provide you with balanced information so you can make the decision that is right for you.

How can you look after your wellbeing?

A high-risk label can increase anxiety about your pregnancy. This is entirely understandable. Some things that may help:

• Focus on what you can control. Attending appointments, taking prescribed medication, eating well, and staying gently active are all things within your control.
• Limit time spent researching online. While information can be empowering, late-night searching can also increase anxiety. Stick to trusted sources like the NHS, RCOG, and your care team.
• Talk about how you feel. Whether it is to your partner, a friend, your midwife, or a counsellor, expressing your worries can stop them from building up.
• Ask about perinatal mental health support. Many trusts have specialist perinatal mental health teams who can provide additional support if you are struggling with anxiety or low mood during a high-risk pregnancy.
• Connect with others in similar situations. Charities such as the Twins Trust, Diabetes UK, and Action on Pre-eclampsia have forums and support groups where you can talk to people who understand what you are going through.

Key takeaways

• High risk means closer monitoring, not a guaranteed bad outcome. Many high-risk pregnancies result in healthy babies and parents
• Pre-existing conditions (diabetes, hypertension, thyroid issues) and pregnancy-specific complications (gestational diabetes, pre-eclampsia, growth restriction) are the most common reasons for high-risk status
• Your care will be consultant-led, with additional scans, appointments, and specialist input as needed
• You have the right to understand your care and make informed decisions
• Looking after your mental health is especially important when managing the added stress of a high-risk pregnancy
• Support is available through your care team, the NHS, and specialist charities

Sources

• NHS. High-risk pregnancy. nhs.uk
• NICE Clinical Guideline CG62. Antenatal care for uncomplicated pregnancies. 2008, updated 2019
• NICE Clinical Guideline CG107. Hypertension in pregnancy. 2010, updated 2023
• NICE Guideline NG3. Diabetes in pregnancy. 2015, updated 2020
• RCOG. Pre-eclampsia: information for you. 2022
• RCOG. Small-for-gestational-age fetus: investigation and management. Green-top Guideline No. 31. 2014
• Action on Pre-eclampsia. action-on-pre-eclampsia.org.uk
• Twins Trust. twinstrust.org