While the exact statistics of high-risk pregnancies in Malaysia remain unknown, the ballpark number would be approximately 20 odd percent, according to Dr. Tan Niap Hong – in which a high-risk pregnancy is defined as a pregnancy that poses a greater risk to the mother or baby compared to a normal one.
This interview aims to understand the various conditions that would lead to a high-risk pregnancy; all that it entails; and potential treatments.
Q: What would constitute a high-risk pregnancy?
Dr. TNH: There are no black and white guidelines – it simply means that the risk is higher than usual. For example, age is a risk – but we are unable to settle on a cut-off number. Years ago, it was believed to be 35, but these days, people are getting pregnant later and later.
Q: Are there specific causes for high-risk pregnancies?
Dr. TNH: Most cases are not caused by a single factor. They are multifactorial – a combination of genetic predisposition, environmental factors, and lifestyle choices. A case in point, a person who is susceptible to sugar may consume high amounts of it and end up developing obesity and eventually, diabetes. Meanwhile, another who is less susceptible to sugar may consume the same amount and nothing happens. Similarly, not everyone will develop lung cancer from smoking.
Q: What are some common high-risk pregnancy conditions or categories?
Dr. TNH: The three big groups would be: high blood pressure; diabetes; and premature birth. On the maternal side, age would be a factor as well or pre-existing health issues such as kidney, thyroid, or autoimmune problems. Not to mention, lifestyle habits such as regular consumption of alcohol or smoking.
As for the baby, it’s less common because foetal abnormalities account for about 1 to 2 percent of all pregnancies. It can be a chromosomal disorder, a genetic disorder, or it could be multifactorial. For example, Down syndrome is a chromosomal disorder; dwarfism is a genetic disorder; while a cleft lip or palate is usually multifactorial.
Q: What would your advice be to lower the possibility of a high-risk pregnancy?
Dr. TNH: Live a healthy lifestyle – eat well; cut down on your sugar intake, and get regular exercise. Your BMI is an important indicator – ensure it is within a normal range as both low and high BMI can mean a high complication risk during pregnancy.
Q: What would the next steps be after one is diagnosed?
Dr. TNH: Once a person is diagnosed – be it high risk due to the mother or baby, a possible treatment is always considered first. For example, if the mother is hypertensive or diabetic – it is possible to control blood pressure and blood sugar levels respectively. Following that is close monitoring of the pregnancy to ensure it progresses normally.
Besides, due to the risk factors – one would have to consider the best place or time to deliver the baby. If the baby has a heart condition, the mother cannot deliver her child in a small hospital that lacks paediatric cardiology support. Besides, if a mother has gestational diabetes, the pregnancy shouldn’t go overdue. Hence, at 38 or 39 weeks, if everything looks to be fine, induction of labour or elective delivery may be considered.
Q: Could you elaborate on how lifestyle factors (smoking and drinking) affect pregnancies?
Dr. TNH: For those who drink regularly in the early part of their pregnancy, it may result in foetal alcohol syndrome, which can cause defects in the baby. Meanwhile, smoking decreases blood oxygen and can be linked to an increased possibility of a premature baby and foetal growth restriction (meaning it will grow less well). Therefore, people who intend on falling pregnant should stop drinking and smoking.
Q: Could you elaborate on high-risk pregnancies that end in termination?
Dr. TNH: That is usually very severe in which the continuation of the pregnancy will seriously threaten the life of the mother or baby. A case in point, if a woman with heart disease falls pregnant – despite having been warned against if, by her cardiologist, she may die as her heart will have to work harder throughout her pregnancy. Another well-documented condition is when the mother catches rubella within the first three months of her pregnancy. In such cases, there is a 90 percent chance that the baby will be abnormal in some ways. These are very clear-cut situations in which the parents may want to stop pregnancy. However, most cases are not as clear. As a general rule of thumb, doctors would usually allow the pregnancy to carry on unless its severity is evident.
Q: Can a woman with a normal pregnancy suddenly develop conditions that will turn it into a high-risk one?
Dr. TNH: It’s quite common, such as a woman developing high blood pressure or gestational diabetes along the way. Again, there is no real estimation – it’s all multifactorial.
Q: If a woman’s first pregnancy is a high risk, will her second pregnancy be the same as well?
Dr. TNH: There is a high possibility of this happening. As a lot of cases are multifactorial – even if one were to change their environmental factors and lifestyle habits, the genetic predisposition would remain. There is a 4 percent chance of a mother developing high blood pressure during her first pregnancy. If she does, she runs a risk of 14 percent for her next one, and almost 30 percent for her third. Meanwhile, if one has never developed high blood pressure during pregnancy – there would only be a 1 percent risk in subsequent ones. This indicates that genetic predisposition is a very strong factor.
Q: Are there methods to test if a woman’s pregnancy will turn high-risk?
Dr. TNH: Yes. In cases of high blood pressure potentially developing in pregnancy, it can be effectively screened at about 12 weeks (there is an 80 to 90 percent chance of picking it up) using a combination of blood tests; blood pressure monitoring; historical records; and uterine artery measurement. Once screened for high-risk for preeclampsia (a severe form of hypertension in pregnancy), there is a simple yet efficient preventive method. If the patient is started on a low dose of aspirin before she hits the 16-week mark, there is a 75 percent chance of preventing it from eventually happening. However, this method is not very common in Malaysia and has to be done as early as 11 to 13 weeks into the pregnancy.
For premature births, screening can also occur at about 20 to 24 weeks when an ultrasound scan is done. A vaginal probe is inserted and used to measure the length of the cervix. If it is short, monitoring is needed as further shortening may mean a premature birth.
Q: You mentioned that low doses of aspirin will be prescribed in high blood pressure cases. Does this mean normal doses of aspirin (used for headaches) can affect pregnancies?
Dr. TNH: If one were to take regular high doses of aspirin used for headaches regularly – the baby’s heart vessels may be affected. Therefore, the ones used for preventing preeclampsia come in the form of tablets to be taken daily and are of low dosage. It has also been shown that it doesn’t affect the baby’s health in any way.
Q&A With Dr Tan Niap Hong
Obstetrics And Gynaecology Specialist,
Prince Court Medical Centre
