Module 5: High-Risk Pregnancy
Definition of High-Risk Pregnancy
● A pregnancy that poses greater risks to the mother and/or fetus.
Risk Factors for High-Risk Pregnancy
● High Blood Pressure (Hypertension)
● Diabetes (Type 1, Type 2, Gestational)
● HIV
● History of prior pregnancy complications
● High BMI (Obesity)
● Advanced Maternal Age (AMA) >35 years or <18 years
● Use of illegal substances (impacts pregnancy and delivery outcomes)
● Preterm labor
Multiple Gestation
● Definition: Pregnancy with more than one fetus
● Placenta Types:
○ Monochorionic – One chorion, risk for Twin-to-Twin Transfusion Syndrome (TTTS)
○ Dichorionic – Two chorions
● Types of Twins:
○ Monozygotic: Identical, same gender, single zygote splits
■ Dichorionic/Diamniotic
■ Monochorionic/Diamniotic
■ Monochorionic/Monoamniotic (high risk for cord entanglement)
○ Dizygotic: Fraternal, two eggs fertilized, can be same or different gender
■ Always dichorionic/diamniotic
● Maternal Risks: Hypertension (HTN), Pre-eclampsia (Pre-E), Gestational Diabetes Mellitus (GDM),
hemorrhage, abruptions, previa, preterm labor (PTL), cord prolapse
● Fetal Risks: Low birth weight (LBW), increased mortality, TTTS
Hyperemesis Gravidarum
● Cause: Uncontrolled vomiting due to increased pregnancy hormones
● Risks: Dehydration, ketosis, electrolyte imbalances
● Treatment:
○ Intravenous fluids (IVF)
○ Anti-nausea medications
○ Gut rest, Vitamin B6, dextrose, correct ketosis
,Intrahepatic Cholestasis of Pregnancy (ICP)
● Definition: Reversible liver disorder
● Symptoms: Severe itching (pruritus)
● Risks: Intrauterine fetal demise (IUFD), preterm delivery (PTD), meconium-stained amniotic fluid
● Treatment: Ursodeoxycholic acid (UDCA), monitoring bile acid levels
Diabetes in Pregnancy
1. Types of Diabetes in Pregnancy
● Type 1 Diabetes (T1DM):
○ Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency
○ Requires insulin therapy for life
● Type 2 Diabetes (T2DM):
○ Insulin resistance → Often managed with diet, exercise, and medications
○ May require insulin during pregnancy
● Pregestational Diabetes:
○ Diabetes diagnosed before pregnancy (T1DM or T2DM)
○ Higher risk for fetal complications
● Gestational Diabetes Mellitus (GDM):
○ Glucose intolerance first diagnosed during pregnancy
○ Placental hormones create insulin resistance
○ Usually resolves after delivery, but increases risk of T2DM later
2. Placental Hormones & Insulin Resistance
● The placenta produces insulin antagonists, which increase maternal insulin resistance:
○ Human Placental Lactogen (hPL)
○ Progesterone
○ hCG (human chorionic gonadotropin)
● These hormones increase in the second and third trimesters, causing higher blood sugar levels.
3. Diagnosing Gestational Diabetes (GDM)
Screening occurs between 24-28 weeks gestation.
Step 1: 1-Hour Glucose Challenge Test (Non-Fasting)
● 50g oral glucose load → Blood sugar checked after 1 hour
● Failed if > 140 mg/dL → Proceed to Step 2
, Step 2: 3-Hour Oral Glucose Tolerance Test (Fasting Test)
● 100g oral glucose load
● Fasting & post-load glucose levels checked at 1, 2, and 3 hours
● Diagnosis of GDM if 2+ values exceed:
○ Fasting > 95 mg/dL
○ 1-hour > 180 mg/dL
○ 2-hour > 155 mg/dL
○ 3-hour > 140 mg/dL
4. Risk Factors for GDM
● Obesity (BMI > 30)
● Family history of diabetes
● Previous GDM pregnancy
● Previous macrosomic infant (>4,000 g)
● PCOS (Polycystic Ovary Syndrome)
● Age > 25 years
● Hypertension
● History of stillbirth or unexplained pregnancy loss
5. Maternal & Fetal Risks of GDM
Maternal Risks:
● Pre-Eclampsia
● C-section (due to macrosomia)
● Increased risk of developing Type 2 Diabetes postpartum
● Hypoglycemia (if insulin-dependent)
● Diabetic Ketoacidosis (DKA) (mostly in Type 1 DM, but possible in GDM)
Fetal Risks:
● Macrosomia (birth weight > 4,000 g) → Risk of birth trauma & shoulder dystocia
● IUGR (if placenta is affected by poor glycemic control)
● Neonatal Hypoglycemia (baby overproduces insulin post-delivery)
● Respiratory Distress Syndrome (RDS) (delayed lung maturation due to high maternal glucose)
● Hyperbilirubinemia & Polycythemia (due to fetal hypoxia)
Definition of High-Risk Pregnancy
● A pregnancy that poses greater risks to the mother and/or fetus.
Risk Factors for High-Risk Pregnancy
● High Blood Pressure (Hypertension)
● Diabetes (Type 1, Type 2, Gestational)
● HIV
● History of prior pregnancy complications
● High BMI (Obesity)
● Advanced Maternal Age (AMA) >35 years or <18 years
● Use of illegal substances (impacts pregnancy and delivery outcomes)
● Preterm labor
Multiple Gestation
● Definition: Pregnancy with more than one fetus
● Placenta Types:
○ Monochorionic – One chorion, risk for Twin-to-Twin Transfusion Syndrome (TTTS)
○ Dichorionic – Two chorions
● Types of Twins:
○ Monozygotic: Identical, same gender, single zygote splits
■ Dichorionic/Diamniotic
■ Monochorionic/Diamniotic
■ Monochorionic/Monoamniotic (high risk for cord entanglement)
○ Dizygotic: Fraternal, two eggs fertilized, can be same or different gender
■ Always dichorionic/diamniotic
● Maternal Risks: Hypertension (HTN), Pre-eclampsia (Pre-E), Gestational Diabetes Mellitus (GDM),
hemorrhage, abruptions, previa, preterm labor (PTL), cord prolapse
● Fetal Risks: Low birth weight (LBW), increased mortality, TTTS
Hyperemesis Gravidarum
● Cause: Uncontrolled vomiting due to increased pregnancy hormones
● Risks: Dehydration, ketosis, electrolyte imbalances
● Treatment:
○ Intravenous fluids (IVF)
○ Anti-nausea medications
○ Gut rest, Vitamin B6, dextrose, correct ketosis
,Intrahepatic Cholestasis of Pregnancy (ICP)
● Definition: Reversible liver disorder
● Symptoms: Severe itching (pruritus)
● Risks: Intrauterine fetal demise (IUFD), preterm delivery (PTD), meconium-stained amniotic fluid
● Treatment: Ursodeoxycholic acid (UDCA), monitoring bile acid levels
Diabetes in Pregnancy
1. Types of Diabetes in Pregnancy
● Type 1 Diabetes (T1DM):
○ Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency
○ Requires insulin therapy for life
● Type 2 Diabetes (T2DM):
○ Insulin resistance → Often managed with diet, exercise, and medications
○ May require insulin during pregnancy
● Pregestational Diabetes:
○ Diabetes diagnosed before pregnancy (T1DM or T2DM)
○ Higher risk for fetal complications
● Gestational Diabetes Mellitus (GDM):
○ Glucose intolerance first diagnosed during pregnancy
○ Placental hormones create insulin resistance
○ Usually resolves after delivery, but increases risk of T2DM later
2. Placental Hormones & Insulin Resistance
● The placenta produces insulin antagonists, which increase maternal insulin resistance:
○ Human Placental Lactogen (hPL)
○ Progesterone
○ hCG (human chorionic gonadotropin)
● These hormones increase in the second and third trimesters, causing higher blood sugar levels.
3. Diagnosing Gestational Diabetes (GDM)
Screening occurs between 24-28 weeks gestation.
Step 1: 1-Hour Glucose Challenge Test (Non-Fasting)
● 50g oral glucose load → Blood sugar checked after 1 hour
● Failed if > 140 mg/dL → Proceed to Step 2
, Step 2: 3-Hour Oral Glucose Tolerance Test (Fasting Test)
● 100g oral glucose load
● Fasting & post-load glucose levels checked at 1, 2, and 3 hours
● Diagnosis of GDM if 2+ values exceed:
○ Fasting > 95 mg/dL
○ 1-hour > 180 mg/dL
○ 2-hour > 155 mg/dL
○ 3-hour > 140 mg/dL
4. Risk Factors for GDM
● Obesity (BMI > 30)
● Family history of diabetes
● Previous GDM pregnancy
● Previous macrosomic infant (>4,000 g)
● PCOS (Polycystic Ovary Syndrome)
● Age > 25 years
● Hypertension
● History of stillbirth or unexplained pregnancy loss
5. Maternal & Fetal Risks of GDM
Maternal Risks:
● Pre-Eclampsia
● C-section (due to macrosomia)
● Increased risk of developing Type 2 Diabetes postpartum
● Hypoglycemia (if insulin-dependent)
● Diabetic Ketoacidosis (DKA) (mostly in Type 1 DM, but possible in GDM)
Fetal Risks:
● Macrosomia (birth weight > 4,000 g) → Risk of birth trauma & shoulder dystocia
● IUGR (if placenta is affected by poor glycemic control)
● Neonatal Hypoglycemia (baby overproduces insulin post-delivery)
● Respiratory Distress Syndrome (RDS) (delayed lung maturation due to high maternal glucose)
● Hyperbilirubinemia & Polycythemia (due to fetal hypoxia)
