Becoming a parent is a huge milestone—and while we all hope for a smooth nine months, the truth is that some pregnancies need a little more tender, love, and care.
To unpack the realities of high-risk pregnancies in a way that’s medically sound but also parent-friendly, we sat down with Dr Muniswaran Ganeshan, a maternal fetal medicine specialist. He breaks down the science, the symptoms, and the support—all in a way that feels like having a very smart friend walk you through it.
FAQ on High Risk Pregnancy
Q: How does maternal obesity affect a high-risk pregnancy?
Dr Muniswaran: Obesity—especially Class III or morbid obesity, which refers to a BMI over 40—has a considerable impact on pregnancy outcomes. We’re talking about a significantly higher risk for gestational diabetes, preeclampsia, venous thromboembolism, postpartum haemorrhage, and caesarean delivery. There’s also a link with obstructive sleep apnoea (OSA), which can go undiagnosed.
For women planning to conceive, especially those in the obese range, one preventive approach that’s gaining traction is bariatric surgery before pregnancy. Reducing weight pre-conception can lower many of these risks.
Q: How do I know if I have a high-risk pregnancy?
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Dr Muniswaran: Your midwife or obstetrician should flag any risk factors during your routine prenatal visits. Some women go into pregnancy already diagnosed with chronic conditions (like diabetes or hypertension), while others may develop complications mid-way through.
If you’re unsure or just want peace of mind, consult a maternal fetal medicine (MFM) specialist. They’re the experts in all things high-risk and can guide you with tailored advice.
Q: What are the common signs or conditions that point to a high-risk pregnancy?
Dr Muniswaran: Several situations can make a pregnancy high-risk. Common examples include:
Some of these conditions are pre-existing, and some can develop during pregnancy, so regular prenatal check-ups are crucial.
Q: Is gestational diabetes really that serious?
Dr Muniswaran: It can be if not well managed. While not as severe as pre-existing diabetes, gestational diabetes still requires close monitoring. The good news? Around 80% of cases can be controlled through diet, exercise, and lifestyle tweaks.
If caught early and managed well, gestational diabetes doesn’t usually cause long-term issues for mother or baby.
Q: Why is prenatal care such a big deal for high-risk pregnancies?
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Dr Muniswaran: Pre-pregnancy care sets the stage for a safer pregnancy. It’s about ensuring that you’re:
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Taking the right medications (and the right dose)
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On appropriate supplements
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At a healthy weight
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Free of uncontrolled conditions or infections
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Fully vaccinated
Pre-conception is also a good time for your partner to check their health too. It’s truly a team effort.
Q: What are the most important considerations when managing a high-risk pregnancy?
Dr Muniswaran: First and foremost, acknowledge that you’re high-risk. Many parents hesitate to use the label, but embracing it early allows for better planning and care. Next:
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See a specialist, ideally an MFM expert
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Engage in pre-pregnancy care
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Eat well and stay active (as much as your OB allows)
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Stay on top of your vaccinations
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Avoid smoking, alcohol, and other risk factors
It’s all about risk reduction through proactive steps.
Q: What are some of the typical risk factors?
Dr Muniswaran: Everyone is different, but some red flags include:
Q: What treatment options are available for high-risk pregnancies?
Dr Muniswaran: It really depends on the cause. For example:
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Aspirin is often prescribed to prevent preeclampsia
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SLE medications can be continued safely with the right adjustments
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Even chemotherapy and surgery are possible in pregnancy for conditions like breast cancer
The takeaway: Don’t assume treatment isn’t an option—speak with your specialist.
Q: What resources or support are available?
Dr Muniswaran: Support groups are often condition-specific. You can find groups for:
Q: What complications can arise in high-risk pregnancies?
Dr Muniswaran: It varies by diagnosis, but the usual suspects include:
Each case is unique, so your care plan should be too.
Q: Can mental health issues impact a high-risk pregnancy?
Dr Muniswaran: Absolutely. Pregnancy is already an emotional rollercoaster, and high-risk situations can intensify that. Conditions like anxiety or depression can affect both mum and baby, especially postpartum.
Therapies like CBT and medications (yes, many are pregnancy-safe) can help. If you’re feeling overwhelmed, hopeless, or detached from your baby, please speak to a professional. Mental health is health.
Q: Any dietary dos and don’ts?
Dr Muniswaran: Again, this depends on your specific condition, but general advice includes:
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Folic acid: 5mg daily (vs. the usual 400mcg) if you’re high risk
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Vitamin D3: 1,000 IU daily
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Tailored plans for conditions like anemia, post-bariatric surgery, or diabetes
Q: I’ve had a miscarriage or preterm birth. Does that mean I’m high-risk?
Dr Muniswaran: A history of recurrent miscarriages (three or more) or previous premature delivery automatically places you in the high-risk category. These warrant a deeper investigation and specialist review.
Q: Can I drink or smoke during a high-risk pregnancy?
Dr Muniswaran: The short answer? No. There’s no safe level of alcohol or tobacco use during pregnancy, whether it’s cigarettes or vaping. And secondhand smoke matters too. If you’re pregnant, those around you—especially partners—should quit too.
Q: Is exercise safe if I’m high-risk?
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Dr Muniswaran: For most, yes—moderate, low-impact exercise like walking or swimming is highly recommended. The current guideline suggests 140 minutes per week (or 20 minutes a day). Always get your doctor’s green light before starting.
Q: What lifestyle changes really make a difference?
Dr Muniswaran: Start with:
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Folic acid and Vitamin D3
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Pre-conception aspirin (for some women)
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Balanced meals
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Safe levels of activity
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Staying away from smoke and alcohol
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Staying vaccinated (COVID-19, influenza, etc.)
Every small change adds up.
Q: What are the extra challenges if the pregnant mum is a teenager?
Dr Muniswaran: Teen pregnancies are considered high risk, partly due to social and nutritional vulnerabilities. Care strategies often include:
Support systems are key here—not just medical but emotional too.
Q: What about risks for twins or triplets?
Dr Muniswaran: Multiple pregnancies raise the stakes on both sides. For mothers:
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Anemia
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Gestational diabetes
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Preeclampsia
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Caesarean complications
For babies:
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Higher risk of anomalies
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Preterm delivery
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Growth restrictions
Expect more scans, more check-ups, and possibly earlier delivery dates.
Q: How does a high-risk pregnancy impact the baby’s long-term health?
Dr Muniswaran: Conditions like fetal growth restriction and premature birth can increase a child’s risk of future cardiovascular or metabolic disorders. However, interventions like low-dose aspirin, lifestyle changes, and early specialist care can dramatically improve outcomes.
Q: I had a previous C-section. Am I automatically high-risk?
Dr Muniswaran: Yes, especially if you’ve had multiple C-sections or complications like uterine rupture, placenta accreta, or infection. That doesn’t mean you can’t have a healthy pregnancy, but it does mean your obstetrician will watch things a little more closely.
About Dr Muniswaran
Source: NST
Dr Muniswaran Ganeshan is a Malaysia-based Maternal Fetal Medicine Specialist with a focus in Obstetrics & Gynaecology (O&G).
He is passionate about managing high-risk pregnancies and advancing maternal care. His research interests include preeclampsia, maternal-fetal medicine, and the placenta.
Final Thoughts on High Risk Pregnancy
The phrase “high-risk pregnancy” can sound scary. But here’s the truth…
With the right care, support, and planning, many high-risk pregnancies lead to healthy births. The key is early action—know your risks, build your care team, and don’t be afraid to ask questions.
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