Preconception planning for high-risk pregnancy

6 ways to get healthy now with tips from a maternal-fetal medicine specialist

Preconception planning for high-risk pregnancy

Before you get pregnant, Maria Schmoll, M.D., wants you in your best health.

Like customizing settings on your smartphone before you start to use it, you can reduce the risk of pregnancy complications by adjusting now.

Granted, making changes to your health is more complicated than toggling on or off. Helping to manage those settings are OB/GYNs like Dr. Schmoll, a maternal-fetal medicine specialist at Sanford Maternal-Fetal Medicine in Sioux Falls, South Dakota. She sees patients with a range of health conditions from mild to severe.

“The spectrum of things we optimize is very broad and very complicated at times,” Dr. Schmoll said. “And the extra component of that is there’s always two patients to consider, both Mom and Baby, and we’re trying to optimize health for both of them.”

Dr. Schmoll shares what contributes to high-risk pregnancy and what to do about it.

What makes a pregnancy high risk?

High-risk pregnancy means you or your baby has one or more complications that could affect your health, your baby’s health or likelihood for early delivery. Your pregnancy might be considered high-risk if you:

  • Are age 17 or younger
  • Are age 35 or older
  • Were underweight or overweight before becoming pregnant
  • Are pregnant with twins, triplets or other multiples
  • Have had problems with previous pregnancies, including multiple miscarriages, preterm labor or having a child with a genetic problem or birth defect
  • Have an existing chronic health problem, especially:
    • Depression
    • Diabetes
    • Heart disease
    • High blood pressure
    • Seizure disorders

Certain health issues that develop during pregnancy also can increase your risk of other conditions later in life.

Planning to lower your risks

For a safe and healthy pregnancy, you and your health care provider can work together to plan the steps for getting there. Dr. Schmoll says preconception health care can look like this:

1.     See your health care provider

If you’re thinking about starting a family and have any high-risk conditions, your primary care provider may recommend adding a maternal-fetal medicine specialist to your pregnancy care team.

“We would recommend an MFM preconception consultation with any kind of maternal (complications) or history of fetal complications, just to talk about how to prevent more complications from developing, how to optimize pregnancy and how to have the healthiest pregnancy for those nine months and then postpartum as well,” said Dr. Schmoll.

2.     Review your medical conditions

Chronic health conditions can appear during pregnancy, become worse during pregnancy, and cause complications with your pregnancy.

For these reasons, Dr. Schmoll said it’s best to optimize your health at least six months before becoming pregnant. If you have chronic health conditions, such as diabetes, asthma, cystic fibrosis, lupus, heart or liver problems, or thyroid issues, this means you have them under control for half a year or more before attempting pregnancy.

“When lupus is controlled or in remission at least six months prior to conception, the risk of complications is significantly lower,” she said.

Also consider any medications you’re taking, and ask your provider whether it’s safe to keep taking them during pregnancy.

3.     Learn your family history

Birth defects or genetic disorders from either or both parents have the potential to affect your baby’s health.

To help determine your risk, you’ll answer some family health history questions at your preconception appointment.

If your health care providers identify a concern, they will discuss the diagnosis and other tests and consultations you’ll need. You also will meet with any additional specialists involved in your care, such as a genetic counselor. They’ll explain what they find and discuss treatments they recommend.

4.     Reach and maintain a healthy weight

Starting pregnancy at a healthy weight can help reduce the risk of preeclampsia, pregnancy loss and cesarean delivery, according to the Centers for Disease Control and Prevention. Current guidelines identify risk with a maternal body mass index of less than 18.5 or more than 30.

“There are definitely people who are healthy with higher BMI, but we still need to use a number for our risk assessment, and we know that our risk goes up with that,” she said.

Another risk is developing gestational diabetes, a form of diabetes that develops during pregnancy. If you’re diagnosed with gestational diabetes, you’ll need to monitor your blood sugar level for the rest of your pregnancy.

Beyond that, half of women who have gestational diabetes develop type 2 diabetes later in life, said Dr. Schmoll. She recommends every pregnant person be screened for diabetes in their third trimester, and everyone with gestational diabetes be screened again six weeks postpartum.

5.     Stop drinking alcohol, smoking and taking certain drugs

Drinking and smoking before pregnancy increase your risk of preterm birth, pregnancy loss and birth defects. Dr. Schmoll recommends women stop all alcohol, smoking and drug use before becoming pregnant.

“In that first trimester, there is significant organ development, and alcohol can affect that,” she said, citing the American College of Obstetricians and Gynecologists. “And then throughout the remainder of their pregnancy, because it can affect neural development, ACOG makes a very strong stance that no amount of alcohol is safe in pregnancy.”

Similarly, doctors do not recommend using any illicit drugs if you’re planning to become pregnant – including methamphetamines, opioids, benzodiazepines and marijuana. However, some medications used in treatment for substance use disorders are safe and effective during pregnancy, Dr. Schmoll said.

Talk to your primary care provider if you need help quitting.

6.     Take care of your mental health

Stress and worry are common even when you’re not trying to get pregnant. But letting stress build up before or during pregnancy can cause high blood pressure, low birth weight and higher risk of infection. So find ways to lower stress for your health and that of any future baby.

What if it’s more than everyday stress? If you find negative thoughts and feelings are interfering with your daily life, it’s time to find help. Mental health conditions like anxiety and depression are treatable – and most psychiatric medications are safe to take during pregnancy, said Dr. Schmoll.

“Treating Mom’s mental health is just as important (as physical health),” she said. “When it’s not treated, we do see an increase in risk of growth restriction, early delivery and other pregnancy complications.”

Help is available. If you’re thinking about suicide or self-harm, call or text the 988 Suicide and Crisis Lifeline at 988, chat at, or call 211 now. Sanford Behavioral Health offers a variety of programs, so you can get the level of treatment you need.

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Posted In Pregnancy, Sioux Falls, Specialty Care, Women's