Pregnancy

High-Risk Pregnancy: What It Means and When to See a Maternal-Fetal Medicine Specialist

By the Find Her Doctor editorial team · Updated November 1, 2026 · 6 min read

A high-risk pregnancy is one with a higher-than-average chance of health problems for you, the baby or both. It can come from a condition you had before pregnancy, something that develops during it, or carrying more than one baby. Most people with high-risk pregnancies still have healthy outcomes, especially with early care from a maternal-fetal medicine (MFM) specialist working alongside their OB/GYN or midwife.

Hearing "high risk" at a prenatal visit is scary. Many people walk out picturing the worst. In practice, the label mostly means "we're going to watch more closely," which usually translates to extra ultrasounds and a few more appointments.

What makes a pregnancy high risk?

There's no single checklist. Common reasons fall into four groups.

Health conditions you already have

• Chronic high blood pressure
• Type 1 or type 2 diabetes
• Heart disease or kidney disease
• Autoimmune disease, such as lupus or antiphospholipid syndrome
• Thyroid disease that isn't well controlled
• Epilepsy or other seizure disorders
• Blood clotting disorders or a history of blood clots
• Sickle cell disease
• Obesity, especially alongside other conditions
• HIV, hepatitis B or hepatitis C
• A past organ transplant or cancer treatment
• Mental health or substance use conditions that need careful medication planning

Your past pregnancies

• Preterm birth
• Preeclampsia
• Stillbirth or recurrent pregnancy loss
• A baby with a birth defect or genetic condition
• Previous uterine surgery, such as fibroid removal or more than one C-section

Something in this pregnancy

• Twins, triplets or more
• Preeclampsia or gestational hypertension
• Gestational diabetes that needs medication
• Placenta problems, such as placenta previa or placenta accreta spectrum
• A short cervix or signs of preterm labor
• A baby growing too slowly, or a finding on the anatomy scan
• A high-risk result on genetic screening
• Rh or other blood antibody problems

Age. Being 35 or older, or younger than 17, raises the chance of certain complications. Age alone doesn't always mean you need a specialist.

What is a maternal-fetal medicine specialist?

An MFM specialist (also called a perinatologist) finished an OB/GYN residency and then several more years of fellowship focused on complicated pregnancies. Their expertise:

• Detailed ("level 2") ultrasound and fetal diagnosis
• Prenatal genetic testing, including CVS and amniocentesis
• Managing chronic medical conditions in pregnancy
• Complications like preeclampsia, fetal growth problems and preterm labor
• Twins and other multiples
• Planning the timing and setting of delivery

Most MFM specialists are based at or affiliated with hospitals that have higher-level maternity and newborn units.

When MFM gets involved

Your OB/GYN or midwife usually sends the referral.

If you have a chronic condition and you're thinking about getting pregnant, a preconception visit with MFM can get your health and medications in good shape before you conceive. It's one of the most underused appointments in pregnancy care.

Your first MFM visit, step by step

1. Check-in and history. Bring your medication list, records from past pregnancies and any specialist notes (cardiology, endocrinology, rheumatology). The MFM team will ask a lot of questions.
2. The ultrasound. Many first visits include a detailed scan. It takes longer than a routine one, often 30 to 60 minutes, because the sonographer measures a lot. Silence during the scan is normal; it doesn't mean they've found something.
3. The conversation. The MFM doctor reviews the images and your history and explains the plan. Ask them to spell out exactly what makes your pregnancy high risk.
4. The follow-up plan. You'll leave knowing how often to come back and whether care is shared with your OB.

Tip: plan for the whole visit to take two to three hours, and don't schedule anything tight after it.

How care is shared

• Consultation: you see MFM once or a few times, and they send recommendations to your OB/GYN.
• Co-management: you alternate or combine visits, with MFM handling ultrasounds and complex decisions.
• Transfer of care: for some complex conditions, MFM provides most of your prenatal care.

What extra monitoring feels like

• More frequent visits, sometimes every week or two later on
• Growth ultrasounds that check the baby's size, fluid and blood flow (Doppler)
• Non-stress tests in the third trimester: two belts on your belly track the baby's heart rate for about 20 to 40 minutes while you sit in a recliner. Bring a snack and something to read.
• Biophysical profiles, an ultrasound that checks the baby's movement, tone, breathing motions and fluid
• More lab work
• Home blood pressure or blood sugar checks, often logged in an app or notebook

In New York City, the hardest part of all this is often logistics. Weekly testing in the third trimester can mean a lot of subway stairs. Ask whether any of it can happen at a satellite office closer to home, and whether you can stack appointments on the same day.

Planning where you'll deliver

Your team may recommend delivering at a hospital with a higher level of maternal and newborn intensive care and may plan the timing of delivery around your condition. New York State designates hospitals by perinatal level. Regional Perinatal Centers provide the highest level of care for the most complex pregnancies and newborns. Large academic medical centers in Manhattan, the Bronx, Brooklyn, Queens, Long Island and Westchester offer MFM services, and many MFM practices also see patients at satellite offices across the Hudson Valley and Long Island.

When choosing, weigh:

• Where your OB/GYN delivers, and whether MFM works at that hospital
• The NICU level, if preterm birth is possible
• Travel time, especially for frequent visits
• Whether your insurance, including NY Medicaid managed care, is accepted

Insurance

MFM consultations, ultrasounds and testing are generally covered when medically necessary. Many HMO and Medicaid managed care plans require a referral or prior authorization first. Ask your OB's office to send the referral, and confirm that the MFM practice and its hospital are in your network before your first visit.

Questions to ask your MFM specialist

• What specifically makes my pregnancy high risk?
• Will you co-manage with my OB/GYN or midwife, or take over?
• How often will I need ultrasounds or fetal testing?
• Which of my medications should change?
• Do I need to deliver at a particular hospital?
• What symptoms should make me call, and who do I call after hours?

Taking care of yourself

Anxiety and depression are common in high-risk pregnancies, and they're worth mentioning at any visit. Practical things that help: knowing exactly which symptoms mean "call now," writing questions down before each visit, and saying yes when someone offers to come with you or pick up groceries.

When to call your provider

With a high-risk pregnancy, call your care team right away for:

• Vaginal bleeding or leaking fluid
• Regular contractions, cramping or pelvic pressure before 37 weeks
• A severe headache, vision changes, upper belly pain or sudden swelling
• Blood pressure or blood sugar readings outside the range you were given
• Less movement from your baby than usual
• Fever, chest pain, shortness of breath, or swelling and pain in one leg

Call 911 for heavy bleeding, a seizure, severe chest pain or trouble breathing.

To find a specialist, browse our maternal-fetal medicine directory, or start locally with MFM specialists in Brooklyn or Queens.

Frequently asked questions

Sources

• ACOG and SMFM — Levels of Maternal Care (Obstetric Care Consensus)
• Society for Maternal-Fetal Medicine — What Is a Maternal-Fetal Medicine Subspecialist?
• NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development — High-Risk Pregnancy
• ACOG — Pregnancy and chronic conditions patient FAQs

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.