Risk Factors affecting Pregnancy

a. Age

 Young age. Pregnant teens are more likely to develop pregnancy-related high blood
pressure and anemia (lack of healthy red blood cells) and to go through preterm (early)
labor and delivery than women who are older. Teens are also more likely to not know
they have a sexually transmitted infection (STI). Some STIs can cause problems with the
pregnancy or for the baby. Teens may be less likely to get prenatal care or to keep
prenatal appointments. Prenatal care is important because it allows a healthcare provider
to evaluate, identify, and treat risks, such as counseling teens not to take certain
medications during pregnancy, sometimes before these risks become problems.
 First-time pregnancy after age 35. Most older first-time mothers have normal
pregnancies, but research shows that older women are at higher risk for certain problems
than younger women, including:
o Pregnancy-related high blood pressure (called gestational hypertension) and
diabetes (called gestational diabetes)
o Pregnancy loss
o Ectopic pregnancy (when the embryo attaches itself outside the uterus), a
condition that can be life-threatening
o Cesarean (surgical) delivery
o Delivery complications, such as excessive bleeding
o Prolonged labor (lasting more than 20 hours)
o Labor that does not advance
o Genetic disorders, such as Down syndrome, in the baby

b. Parity (Multiple Births)

c. Pre- Existing disease

 High blood pressure. Even though high blood pressure can be risky for the mother and
fetus, most women with slightly high blood pressure and no other diseases have healthy
pregnancies and healthy deliveries because they get their blood pressure under control
before pregnancy. Uncontrolled high blood pressure, however, can damage the mother’s
kidneys and increase the risk for low birth weight or preeclampsia.1 It is very important
 for women to have their blood pressure checked at every prenatal visit so that healthcare
providers can detect any changes and make decisions about treatment.
 Polycystic ovary syndrome (PCOS). Women with PCOS have higher rates of
pregnancy loss before 20 weeks of pregnancy, diabetes during pregnancy (gestational
diabetes), preeclampsia, and cesarean section.2
 Diabetes. It is important for women with diabetes to manage their blood sugar levels
both before getting pregnant and throughout pregnancy. During the first few weeks of
pregnancy, often before a woman even knows she is pregnant, high blood sugar levels
can cause birth defects. Even women whose diabetes is well under control may have
changes in their metabolism during pregnancy that require extra care or treatment to
promote a healthy birth.3 Babies of mothers with diabetes tend to be large and are likely
to have low blood sugar soon after birth. That is another reason for women with diabetes
to keep tight control of their blood sugar.
 Kidney disease. Women with mild kidney disease often have healthy pregnancies. But
kidney disease can cause difficulties getting and staying pregnant as well as problems
during pregnancy, including preterm delivery, low birth weight, and preeclampsia. Nearly
one-fifth of women who develop preeclampsia early in pregnancy are found to have
undiagnosed kidney disease.4 Pregnant women with kidney disease require additional
treatments, changes in diet and medication, and frequent visits to their healthcare
provider.5,6
 Autoimmune disease. Conditions such as lupus and multiple sclerosis can increase a
women’s risk for problems during pregnancy and delivery. For example, women with
lupus are at increased risk for preterm birth and stillbirth. Some women may find that
their symptoms improve during pregnancy, while others have flare-ups and other
challenges. Certain medicines to treat autoimmune diseases may be harmful to the fetus,
meaning a woman with an autoimmune disease will need to work closely with a
healthcare provider throughout pregnancy.7
 Thyroid disease. The thyroid is a small gland in the neck that makes hormones that help
control heart rate and blood pressure. Uncontrolled thyroid disease, such as an overactive
or underactive thyroid, can cause problems for the fetus, such as heart failure, poor
weight gain, and brain development problems. Thyroid problems are usually treatable
with medicine or surgery.8 However, a recent NICHD-supported study found that treating
mildly low thyroid function during pregnancy did not improve outcomes for mothers or
their babies.
 Obesity. Being obese before pregnancy is associated with a number of risks for poor
pregnancy outcomes. For example, obesity increases a woman’s chance of developing
 diabetes during pregnancy, which can contribute to difficult births.9 Obesity can also
cause a fetus to be larger than normal, making the birth process more difficult. NICHD
research also found that obesity increases the risk for sleep apnea and disordered sleep
breathing during pregnancy. Obesity before pregnancy is associated with an increased
risk of structural problems with the baby’s heart. There can also be problems if
overweight or obese women gain too much weight during pregnancy. NICHD research
has shown that an integrated approach can help obese women to limit their weight gain
during pregnancy, leading to better pregnancy outcomes. The Institute of Medicine
recommends that overweight women gain no more than 15–25 pounds during pregnancy
and that women with obesity gain no more than 11–20 pounds.10
 HIV/AIDS. HIV can pass to a fetus during pregnancy, labor and delivery, and
breastfeeding. Fortunately, there are effective treatments that can reduce and prevent the
spread of HIV from mother to fetus or child. Medications for the mother and for the
infant, as well as surgical delivery of the baby before the “water breaks” and feeding
formula instead of breastfeeding, can prevent mother-to-child transmission and have led
to a dramatic decrease in transmission—to less than 1% in the United States and other
developed countries.11
 Zika infection. Although scientists and healthcare providers have known about Zika for
decades, the link between Zika infection during pregnancy and pregnancy risks and birth
defects has only recently come to light. NICHD-supported research has shown that
infants born to mothers who were infected with Zika just before and during pregnancy
were at higher risk for different problems with the brain and nervous system. The most
noticeable is microcephaly, a condition in which the head is smaller than normal. Zika
infection during pregnancy can also increase the woman’s risk for pregnancy
loss and stillbirth. Researchers are still just learning the possible mechanisms of Zika’s
effects on pregnancy.

d. Social profile

 Alcohol use. Drinking alcohol during pregnancy can increase the baby’s risk for
fetal alcohol spectrum disorders (FASDs), sudden infant death syndrome, and
other problems. FASDs are a variety of effects on the fetus that result from the
mother’s drinking alcohol during pregnancy. The effects range from mild to
severe, and they include intellectual and developmental disabilities; behavior
problems; abnormal facial features; and disorders of the heart, kidneys, bones,
and hearing. FASDs are completely preventable: If a woman does not drink
 alcohol while she is pregnant, her child will not have an FASD.18

Women who drink also are more likely to have a miscarriage or stillbirth.
Currently, research shows that there is no safe amount of alcohol to drink while
pregnant. According to one study supported by NIH, infants can suffer long-term
developmental problems even with low levels of prenatal alcohol exposure.19
 Tobacco use. Smoking during pregnancy puts the fetus at risk for preterm birth,
certain birth defects, and sudden infant death syndrome (SIDS). One study
showed that smoking doubled or even tripled the risk of stillbirth, or fetal death
after 20 weeks of pregnancy.20 Research has also found that smoking during
pregnancy leads to changes in an infant’s immune system.21 Secondhand smoke
also puts a woman and her developing fetus at increased risk for health
problems.22
 Drug use. Research shows that smoking marijuana and taking drugs during
pregnancy can also harm the fetus and affect infant health. One study showed
that smoking marijuana and using illegal drugs doubled the risk
of stillbirth.20 Research also shows that smoking marijuana during pregnancy can
interfere with normal brain development in the fetus, possibly causing long-term
problems.
 Violence: Intimate partner violence during pregnancy Violence by an intimate partner is
manifested by physical, sexual or emotional abusive acts as well as controlling
behaviours. The majority of studies on intimate partner vio - lence during pregnancy
measure physical violence during pregnancy, although sexual and emotional abuse during
pregnancy are also considered as detrimental for women’s and their children’s well-
being. An especially concerning form of physical violence dur - ing pregnancy is when
abusive partners target a woman’s abdomen, thereby not only hurting the women but also
potentially jeopardizing the pregnancy.
 Abuse before pregnancy and lower education level were found to be strong predictors
of abuse during pregnancy. Pregnancy being unintended by either the victim or the
perpetrator, lower socioeconomic status, and being unmarried were found to be moderate
predictors of abuse during pregnancy.

e. Conditions of pregnancy

 Multiple gestation. Pregnancy with twins, triplets, or more fetuses, called

multiple gestation, increases the risk of infants being born prematurely (before 37
 weeks of pregnancy). Both giving birth after age 30 and taking fertility drugs have
been linked with multiple births. Having three or more infants increases the
chance that a woman will need to have the infants delivered by cesarean section.
Twins and triplets are more likely to be smaller for their size than single infants. If
infants are born prematurely, they are more likely to have difficulty breathing.24
 Gestational diabetes. Gestational diabetes occurs when a woman who didn’t
have diabetes before develops diabetes when she is pregnant. Gestational
diabetes can cause problems for both mother and fetus, including preterm labor
and delivery, and high blood pressure. It also increases the risk that a woman
and her baby will develop type 2 diabetes later in life. Many women with
gestational diabetes have healthy pregnancies because they work with a
healthcare provider to manage their condition.
 Preeclampsia and eclampsia. Preeclampsia is a sudden increase in a pregnant
woman’s blood pressure after the 20th week of pregnancy. It can affect the
mother’s kidneys, liver, and brain. The condition can be fatal for both the mother
and the fetus or cause long-term health problems. Eclampsia is a more severe
form of preeclampsia that includes seizures and possibly coma.
 Previous preterm birth. Women who went into labor or who had their baby early
(before 37 weeks of pregnancy) with a previous pregnancy are at higher risk for
preterm labor and birth with their current pregnancy. Healthcare providers will
want to monitor women at high risk for preterm labor and birth in case treatment
is needed. NICHD research has shown that, among women at high risk for
preterm labor and birth because of a previous preterm birth, giving progesterone
can help delay birth.25 In addition, women who become pregnant within 12
months after their latest delivery may be at increased risk for preterm
birth.26 Women who have recently given birth may want to talk with a healthcare
provider about contraception to help delay the next pregnancy.
 Birth defects or genetic conditions in the fetus. In some cases, healthcare
providers can detect health problems in the fetus during pregnancy. Depending
on the nature of the problems, the pregnancy may be considered high risk
because treatments are needed while the fetus is still in the womb or immediately
after birth. For example, if certain forms of spina bifida are detected in the fetus,
the problems can be repaired before birth. Certain heart problems that are
common among infants with Down syndrome need to be corrected with surgery
immediately after birth. Knowing a fetus has Down syndrome before birth can
help healthcare providers and parents be prepared to give treatment right away.