Every pregnancy has some risk of problems. You may have problems because of a health condition you had before you got pregnant. You could also develop a condition during pregnancy. Other causes of problems during pregnancy can include being pregnant with more than one baby, a health problem in a previous pregnancy, substance abuse during pregnancy, or being over age 35. Any of these can affect your health, the health of your baby, or both.

If you have a chronic condition, you should talk to your health care provider about how to minimize your risk before you get pregnant. Once you are pregnant, you may need a health care team to monitor your pregnancy. Some common conditions that can complicate a pregnancy include

• High blood pressure
• Polycystic ovary syndrome
• Kidney problems
• Autoimmune disorders
• Obesity
• HIV/AIDS
• Cancer
• Infections

Other conditions that can make pregnancy risky can happen while you are pregnant - for example, gestational diabetes and Rh incompatibility. Good prenatal care can help detect and treat them.

Some discomforts, like nausea, back pain, and fatigue, are common during pregnancy. Sometimes it is hard to know what is normal. Call your health care provider if something is bothering or worrying you.

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. When you are pregnant, high blood sugar levels are not good for your baby.

About seven out of every 100 pregnant women in the United States get gestational diabetes. Gestational diabetes is diabetes that happens for the first time when a woman is pregnant. Most of the time, it goes away after you have your baby. But it does increase your risk for developing type 2 diabetes later on. Your child is also at risk for obesity and type 2 diabetes.

Most women get a test to check for diabetes during their second trimester of pregnancy. Women at higher risk may get a test earlier.

If you already have diabetes, the best time to control your blood sugar is before you get pregnant. High blood sugar levels can be harmful to your baby during the first weeks of pregnancy - even before you know you are pregnant. To keep you and your baby healthy, it is important to keep your blood sugar as close to normal as possible before and during pregnancy.

Either type of diabetes during pregnancy increases the chances of problems for you and your baby. To help lower the chances talk to your health care team about

• A meal plan for your pregnancy
• A safe exercise plan
• How often to test your blood sugar
• Taking your medicine as prescribed. Your medicine plan may need to change during pregnancy.

What is high blood pressure in pregnancy?

Blood pressure is the force of your blood pushing against the walls of your arteries as your heart pumps blood. High blood pressure, or hypertension, is when this force against your artery walls is too high. There are different types of high blood pressure in pregnancy:

• Gestational hypertension is high blood pressure that you develop while you are pregnant. It starts after you are 20 weeks pregnant. You usually don't have any other symptoms. In many cases, it does not harm you or your baby, and it goes away within 12 weeks after childbirth. But it does raise your risk of high blood pressure in the future. It sometimes can be severe, which may lead to low birth weight or preterm birth. Some women with gestational hypertension do go on to develop preeclampsia.
• Chronic hypertension is high blood pressure that started before the 20th week of pregnancy or before you became pregnant. Some women may have had it long before becoming pregnant but didn't know it until they got their blood pressure checked at their prenatal visit. Sometimes chronic hypertension can also lead to preeclampsia.
• Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. It usually happens in the last trimester. In rare cases, symptoms may not start until after delivery. This is called postpartum preeclampsia. Preeclampsia also includes signs of damage to some of your organs, such as your liver or kidney. The signs may include protein in the urine and very high blood pressure. Preeclampsia can be serious or even life-threatening for both you and your baby.

What causes preeclampsia?

The cause of preeclampsia is unknown.

Who is at risk for preeclampsia?

You are at higher risk of preeclampsia if you

• Had chronic high blood pressure or chronic kidney disease before pregnancy
• Had high blood pressure or preeclampsia in a previous pregnancy
• Have obesity
• Are over age 40
• Are pregnant with more than one baby
• Are African American
• Have a family history of preeclampsia
• Have certain health conditions, such as diabetes, lupus, or thrombophilia (a disorder which raises your risk of blood clots)
• Used in vitro fertilization, egg donation, or donor insemination

What problems can preeclampsia cause?

Preeclampsia can cause

• Placental abruption, where the placenta separates from the uterus
• Poor fetal growth, caused by a lack of nutrients and oxygen
• Preterm birth
• A low birth weight baby
• Stillbirth
• Damage to your kidneys, liver, brain, and other organ and blood systems
• A higher risk of heart disease for you
• Eclampsia, which happens when preeclampsia is severe enough to affect brain function, causing seizures or coma
• HELLP syndrome, which happens when a woman with preeclampsia or eclampsia has damage to the liver and blood cells. It is rare, but very serious.

What are the symptoms of preeclampsia?

Possible symptoms of preeclampsia include

• High blood pressure
• Too much protein in your urine (called proteinuria)
• Swelling in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
• Headache that does not go away
• Vision problems, including blurred vision or seeing spots
• Pain in your upper right abdomen
• Trouble breathing

Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output. If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.

How is preeclampsia diagnosed?

Your health care provider will check your blood pressure and urine at each prenatal visit. If your blood pressure reading is high (140/90 or higher), especially after the 20th week of pregnancy, your provider will likely want to run some tests. They may include blood tests other lab tests to look for extra protein in the urine as well as other symptoms.

What are the treatments for preeclampsia?

Delivering the baby can often cure preeclampsia. When making a decision about treatment, your provider take into account several factors. They include how severe it is, how many weeks pregnant you are, and what the potential risks to you and your baby are:

• If you are more than 37 weeks pregnant, your provider will likely want to deliver the baby.
• If you are less than 37 weeks pregnant, your health care provider will closely monitor you and your baby. This includes blood and urine tests for you. Monitoring for the baby often involves ultrasound, heart rate monitoring, and checking on the baby's growth. You may need to take medicines, to control your blood pressure and to prevent seizures. Some women also get steroid injections, to help the baby's lungs mature faster. If the preeclampsia is severe, you provider may want you to deliver the baby early.

The symptoms usually go away within 6 weeks of delivery. In rare cases, symptoms may not go away, or they may not start until after delivery (postpartum preeclampsia). This can be very serious, and it needs to be treated right away.

If you are pregnant or planning to get pregnant, it's important to get tested for HIV as soon as possible. If you find out that do have HIV, you can start treatment right away to protect your health and the health of your baby.

If I have HIV, can I pass it on to my baby during pregnancy?

If you are pregnant and have HIV, there is a risk of passing HIV to your baby. It can happen in three ways:

• During pregnancy
• During childbirth, especially if it is vaginal childbirth
• During breastfeeding

But having HIV doesn't mean that you can't have children. Treatment with a combination of HIV medicines can help prevent passing HIV to your baby and protect your own health.

If I have HIV, how can I prevent giving it to my baby?

There are several different steps you can take to help prevent passing HIV to your baby:

• Taking HIV medicines. HIV medicines reduce the amount of HIV in the body (viral load) to a very low level. The goal is to get your viral load so low that a standard lab test can't detect it. This is called having an "undetectable viral load." Having an undetectable viral load is the best thing you can do to stay healthy and prevent your baby from getting HIV.
  
  These medicines will also help protect your health. Most HIV medicines are safe to use during pregnancy. They don't usually raise the risk of birth defects. But it is important to talk with your health care provider about the risks and benefits of the different medicines. Together you can decide which medicines are right for you. Then you need to make sure you take your medicines regularly.
   
• If needed, having a cesarean delivery. If your viral load is not reduced enough by the medicines, having a cesarean delivery (C-Section) can help prevent passing HIV to your baby.
   
• Giving HIV medicines to the baby. Your baby will get HIV medicines as soon as possible after birth. The medicines protect your baby from infection from any HIV that passed from you during childbirth. Which medicine your baby gets depends on several factors, including what your viral load was just before you gave birth. Your baby will need to take medicines for 4 to 6 weeks. He or she will get several HIV tests over the first few months.
   
• Not breastfeeding. Breast milk can have HIV in it. In the United States, infant formula is safe and readily available. So the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend that if you have HIV, you should feed your baby formula instead of breastfeeding.

What if I want to get pregnant and my partner has HIV?

If you are trying to get pregnant, it's important for your partner to also get tested for HIV.

If your partner does have HIV and you do not, talk to your provider about taking PrEP. PrEP stands for pre-exposure prophylaxis. This means taking medicines to prevent HIV. The PrEP helps to protect both you and your baby from HIV.

During pregnancy, some common infections like the common cold or a skin infection do not usually cause serious problems. But other infections can be dangerous to you, your baby, or both. Some infections may lead to preterm birth and low birth weight babies. Others can cause serious illness, birth defects, and lifelong disabilities, such as hearing loss or learning problems.

Some of the infections that can be dangerous during pregnancy include

• Bacterial vaginosis (BV)
• Group B strep (GBS)
• Hepatitis
• Sexually transmitted diseases
• Toxoplasmosis
• Urinary tract infections
• Yeast infections
• Zika virus

To try to prevent infections,

• Don't eat raw or undercooked meat
• Don't share food or drinks with other people
• Wash your hands frequently
• Don't empty cat litter. Cats can transmit toxoplasmosis.

If you do get an infection during pregnancy, contact your health care provider about how best to protect you and your baby. Only some medicines are safe during pregnancy.

During pregnancy, there are many things you can do to keep yourself and your baby healthy. They include getting regular prenatal care, eating healthy, and staying active. But it's also very important to avoid substances that could be harmful to you and your baby, such as tobacco, alcohol, and drugs.

Tobacco

Smoking during pregnancy passes nicotine, carbon monoxide, and many other harmful chemicals to your baby. Nicotine is not only a health danger for you, but it can also damage your developing baby's brain and lungs. Carbon monoxide can keep the developing baby from getting enough oxygen.

If you smoke while pregnant, it raises the risk of your baby being born too small, too early, or with birth defects. During the first year of life, there is a higher risk of your baby dying from sudden infant death syndrome (SIDS). And later in life, your child may be more likely to have health problems, such as asthma and obesity.

Other tobacco products, including e-cigarettes, also contain nicotine and are not safe to use during pregnancy. And some of the flavorings used in e-cigarettes may be harmful to developing babies.

You will also want to try to avoid secondhand smoke, which has some of the same risks as smoking during pregnancy.

Alcohol

There is no known amount of alcohol that is safe for you to drink during pregnancy and while trying to get pregnant. All types of alcohol are equally harmful, including all wines and beer. The risks from drinking during pregnancy include problems with the growth of the developing baby and fetal alcohol spectrum disorders (FASD). FASD is a life-long condition that can cause a mix of physical, behavioral, and learning problems.

Illegal drugs

Using illegal drugs, such as cocaine, methamphetamines, and club drugs, during pregnancy can cause problems for both you and your baby. They may cause low birth weight babies, birth defects, or miscarriage. Your child may be more likely to have learning and developmental disabilities. And if you are injecting the drugs, that puts you at risk for HIV. HIV can be passed along to your baby during pregnancy.

Prescription drug misuse

Misusing prescription drugs can also be harmful. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's medicines. The possible effects of misusing a medicine during pregnancy will depend on which medicine you are misusing.

Opioids

One type of drug that is a concern during pregnancy is opioids. Opioids include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Taking opioids during pregnancy can cause problems for you and your baby. The risks include birth defects, preterm birth, the loss of the baby, and neonatal abstinence syndrome (NAS). NAS causes withdrawal symptoms in newborn babies.

If you have pain and your health care provider suggests that you take prescription opioids during pregnancy, first discuss the risks and benefits with the provider. Then if you both decide that you need to take the opioids, you can work together to try to minimize the risks.

Cannabis (marijuana)

Cannabis (marijuana) is another drug that could be harmful to your baby. Some research shows that using cannabis during pregnancy is linked to developmental problems in children and teens. More research is needed, but the safest thing to do is stop using it if you are pregnant. The U.S. Centers for Disease Control and Prevention (CDC) advises that people should not use cannabis while they are pregnant.

Getting help

If you are pregnant and using any of these substances, contact your provider. Together you and your provider can find the right treatment to help you quit.

If you are taking opioids or are addicted to drugs, don't stop taking them suddenly. That can be dangerous to you and the baby. Instead, contact your provider for help with getting off the drugs safely.

Not all medicines are safe to take when you are pregnant. Some medicines can harm your baby. That includes over-the-counter or prescription drugs, herbs, and supplements.

Always speak with your health care provider before you start or stop any medicine. Not using medicine that you need may be more harmful to you and your baby than using the medicine. For example, many pregnant women take prescription medicines for health problems like diabetes, asthma, seizures, and heartburn. The decision about whether or not to take a medicine depends on the risks and benefits. You and your health care provider should make this choice together.

Pregnant women should not take regular vitamins. They may have too much or too little of the vitamins that you need. There are special vitamins for pregnant women. It is important to take 0.4 mg of folic acid every day before you become pregnant through the first part of your pregnancy. Folic acid helps to prevent birth defects of the baby's brain or spine.

Almost 1 of every 10 infants born in the United States are premature, or preemies. A premature birth is when a baby is born before 37 completed weeks of pregnancy. A full-term pregnancy is 40 weeks.

Important growth and development happen throughout pregnancy - especially in the final months and weeks. Because they are born too early, preemies weigh much less than full-term babies. They may have health problems because their organs did not have enough time to develop. Problems that a baby born too early may have include

• Breathing problems
• Feeding difficulties
• Cerebral palsy
• Developmental delay
• Vision problems
• Hearing problems

Preemies need special medical care in a neonatal intensive care unit, or NICU. They stay there until their organ systems can work on their own.

Prenatal care is the health care you get while you are pregnant. It includes your checkups and prenatal testing. Prenatal care can help keep you and your baby healthy. It lets your health care provider spot health problems early. Early treatment can cure many problems and prevent others.

Your doctor or midwife will give you a schedule for your prenatal visits. If you are over 35 years old or your pregnancy is high risk because of health problems like diabetes or high blood pressure, your doctor or midwife will probably want to see you more often. You can also expect to see your health care provider more often as your due date gets closer.

There are four major blood types: A, B, O, and AB. The types are based on substances on the surface of the blood cells. Another blood type is called Rh. Rh factor is a protein on red blood cells. Most people are Rh-positive; they have Rh factor. Rh-negative people don't have it. Rh factor is inherited through genes.

When you're pregnant, blood from your baby can cross into your bloodstream, especially during delivery. If you're Rh-negative and your baby is Rh-positive, your body will react to the baby's blood as a foreign substance. It will create antibodies (proteins) against the baby's blood. These antibodies usually don't cause problems during a first pregnancy.

But Rh incompatibility may cause problems in later pregnancies, if the baby is Rh-positive. This is because the antibodies stay in your body once they have formed. The antibodies can cross the placenta and attack the baby's red blood cells. The baby could get Rh disease, a serious condition that can cause a serious type of anemia.

Blood tests can tell whether you have Rh factor and whether your body has made antibodies. Injections of a medicine called Rh immune globulin can keep your body from making Rh antibodies. It helps prevent the problems of Rh incompatibility. If treatment is needed for the baby, it can include supplements to help the body to make red blood cells and blood transfusions.

Tumors during pregnancy are rare, but they can happen. Tumors can be either benign or malignant. Benign tumors aren't cancer. Malignant ones are. The most common cancers in pregnancy are breast cancer, cervical cancer, lymphoma, and melanoma. Cancer itself rarely harms the baby, and some cancer treatments are safe during pregnancy. You and your health care provider will work together to find the best treatment. Your options will depend on how far along the pregnancy is, as well as the type, size, and stage of your cancer.

Another type of tumor that women can get is called a gestational trophoblastic disease (GTD). It happens when a fertilized egg doesn't become a fetus. GTD is not always easy to find. It is usually benign, but some types can be malignant. The most common type of GTD is a molar pregnancy. In its early stages, it may look like a normal pregnancy. You should see your health care provider if you have vaginal bleeding (not menstrual bleeding).

Treatment depends on the type of tumor, whether it has spread to other places, and your overall health.

If you are pregnant with more than one baby, you are far from alone. Multiple births are up in the United States. More women are having babies after age 30 and more are taking fertility drugs. Both boost the chance of carrying more than one baby. A family history of twins also makes multiples more likely.

Years ago, most twins came as a surprise. Now, most women know about a multiple pregnancy early. Women with multiple pregnancies should see their health care providers more often than women who are expecting one baby. Multiple pregnancy babies have a much higher risk of being born prematurely and having a low birth weight. There is also more of a risk of disabilities. Some women have to go on bed rest to delay labor. Finally, they may deliver by C-section, especially if there are three babies or more.

Parenting multiples can be a challenge. Volunteer help and support groups for parents of multiples can help.

Several factors can make a pregnancy high risk, including existing health conditions, the mother’s age, lifestyle, and health issues that happen before or during pregnancy.

This page provides some possible factors that could create a high-risk pregnancy situation. This list is not meant to be all-inclusive, and each pregnancy is different, so the specific risks for one pregnancy may not be risks for another. Women who have any questions about their pregnancy should talk to a healthcare provider.

Existing Health Conditions

• 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. 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.
• 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. 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. Pregnant women with kidney disease require additional treatments, changes in diet and medication, and frequent visits to their healthcare provider.
• 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.
• 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. 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.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.
• 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.
• 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.

• 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:
  • Pregnancy-related high blood pressure (called gestational hypertension) and diabetes (called gestational diabetes)
  • Pregnancy loss
  • Ectopic pregnancy (when the embryo attaches itself outside the uterus), a condition that can be life-threatening
  • Cesarean (surgical) delivery
  • Delivery complications, such as excessive bleeding
  • Prolonged labor (lasting more than 20 hours)
  • Labor that does not advance
  • Genetic disorders, such as Down syndrome, in the baby

• 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.
  
  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.
• 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. Research has also found that smoking during pregnancy leads to changes in an infant’s immune system. Secondhand smoke also puts a woman and her developing fetus at increased risk for health problems.
• 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. Research also shows that smoking marijuana during pregnancy can interfere with normal brain development in the fetus, possibly causing long-term problems.

• 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.
• 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. In addition, women who become pregnant within 12 months after their latest delivery may be at increased risk for preterm birth. 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.

It is normal to feel some stress during pregnancy. Your body is going through many changes, and as your hormones change, so do your moods.

Too much stress can cause you to have trouble sleeping, headaches, loss of appetite, or a tendency to overeat—all of which can be harmful to you and your developing baby.

High levels of stress can also cause high blood pressure, which increases your chance of having preterm labor or a low-birth-weight infant.

You should talk about stress with your health care provider and loved ones. If you are feeling stress because of uncertainty or fear about becoming a mother, experiencing work-related stress, or worrying about miscarriage, talk to your health care provider during your prenatal visits.

PTSD is a more serious type of stress that can negatively affect your baby. PTSD occurs when you have problems after seeing or going through a painful event, such as rape, abuse, a natural disaster, or the death of a loved one. You may experience:

• Anxiety
• Flashbacks and upsetting memories
• Nightmares
• Strong physical reactions to situations, people, or things that remind you of the event
• Avoidance of places, activities, and people you once enjoyed
• Feeling more aware of things
• Guilt

PTSD during pregnancy increases the risk of preterm birth and low birth weight. PTSD also increases the risk for behaviors such as smoking and drinking, which contribute to other problems.

Reducing stress is important for preventing problems during your pregnancy and for reducing your risk for health problems that may affect your developing child. Identify the source of your stress and take steps to remove it or lessen it. Make sure you get enough exercise (under a doctor's supervision), eat healthy foods, and get lots of sleep.

Some women experience extreme sadness and/or anxiety during pregnancy and after giving birth. Many sources of information and support are available to help women experiencing depression or anxiety. Moms' Mental Health Matters explains some signs of these problems and provides an action plan for getting help. Talk to your health care provider if you feel overwhelmed, sad, or anxious. Treatment and counseling can help.

Regular prenatal visits help the health care provider identify potential health problems early and take steps to manage them, to protect the health of the mother and the developing fetus. Being aware of the symptoms of these conditions and getting regular prenatal care can prevent health problems and help you get treatment as early as possible.

These problems include:

• Iron Deficiency Anemia
• Gestational Diabetes
• Depression and Anxiety
• Fetal Problems
• High Blood Pressure Related to Pregnancy
• Infections
• Hyperemesis Gravidarum
• Miscarriage
• Placenta Previa
• Placental Abruption
• Preeclampsia
• Preterm Labor

Anemia occurs when your red blood cell count (hemoglobin or hematocrit) is low. Iron deficiency anemia is the most common type of anemia. Iron is part of the hemoglobin that allows blood to carry oxygen. Pregnant women need more iron than normal for the increased amount of blood in their body and for their developing child. Symptoms of iron deficiency include feeling tired or weak, looking pale, feeling faint, or experiencing shortness of breath. Your health care provider may recommend iron and folic acid supplements.

Gestational diabetes occurs when blood sugar levels are found to be too high during pregnancy. The exact number of women affected by gestational diabetes is unknown because of different diagnostic criteria and risk profiles. Most often the condition is discovered using a two-step procedure: screening with the glucose challenge screening test around 24 to 28 weeks of pregnancy, followed by a diagnostic test called the oral glucose tolerance test. Gestational diabetes increases the risk of a baby that is too large (macrosomia), preeclampsia (pronounced pree-i-KLAMP-see-uh, a condition marked by a sudden increase in a pregnant woman's blood pressure along with the presence of protein in the urine after the 20th week of pregnancy), and cesarean birth. Treatment includes controlling blood sugar levels through a healthy diet and exercise, and through medication if blood sugar values remain high.

Many people are familiar with the phrase "postpartum depression," meaning depression that occurs after the birth of a baby. But we now know that it's not just during the postpartum period, and it's not just depression.

Women experience depression and anxiety, as well as other mental health conditions, during pregnancy and after the baby is born. These conditions can have significant effects on the health of the mother and her child.

The NICHD-led Moms' Mental Health Matters initiative is designed to educate consumers and health care providers about who is at risk for depression and anxiety during and after pregnancy, the signs of these problems, and how to get help. The initiative also includes Information for Partners, Family, and Friends on ways to help.

There is no single cause of depression or anxiety during and after pregnancy, but hormonal changes, stress, family history, and changes in brain chemistry or structure may all play a role. Women who have complications during pregnancy are at higher risk for postpartum depression than are women who do not have complications.

Depression can harm the developing fetus if you do not take care of yourself during pregnancy, including attending regular prenatal visits and avoiding alcohol and tobacco smoke. Talk to your health care provider if you feel overwhelmed, sad, or anxious. Even though they are serious conditions, depression and anxiety are treatable.

Possible problems in the fetus include decreased movement after 28 weeks of pregnancy and being measured as smaller than normal. These pregnancies often require closer follow-up including more testing such as ultrasound exams, non-stress testing and biophysical profiles as well as possible early delivery.

Pregnant women who develop high blood pressure will need to be monitored closely for preeclampsia.

Infections, including some sexually transmitted infections (STIs), may occur during pregnancy and/or delivery and may lead to complications for the pregnant woman, the pregnancy, and the baby after delivery. For the latest information on COVID-19 and pregnancy, visit CDC at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html.