The Role of Integrative Medicine For High-Risk Pregnancy Management

Worldwide, 10-30% of pregnancies are deemed “high-risk.” In the United States, about 50,000 people will experience severe pregnancy complications each year. The United States is experiencing an increasing trend in maternal mortality, estimated at 19 deaths per 100,000 live births in 2017. Chronic medical conditions are also contributing to maternal mortality more than ever before. In 2020, 800 women died daily from preventable causes related to pregnancy or childbirth. Receiving adequate prenatal care is associated with lower risks of poor birth outcomes. 

Research shows that women diagnosed with high-risk pregnancies experience a higher level of psychological distress. Incorporating integrative medical care in high-risk pregnancies can not only help to support the mother and baby’s physical well-being but also the mother’s emotional health. Integrative medicine can also be utilized prior to conception to help prevent high-risk complications from occurring during pregnancy.

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What is Considered a High-Risk Pregnancy?

A high-risk pregnancy is any pregnancy in which there is an increased health risk to the mother or the fetus. Women with risk factors have a 1 in 4 chance of developing complications, while women considered low risk have a 1 in 10 chance of developing complications. Factors that influence a high-risk pregnancy include pre-existing health conditions, conditions that develop in relation to pregnancy, certain lifestyle factors like smoking or drug abuse, and age.

Pre-existing maternal health conditions that cause a pregnancy to be considered high-risk include:

• Diabetes
• High blood pressure
• Blood clots
• Autoimmune diseases like Lupus
• Infections like HIV or hepatitis
• Cancer
• Psychiatric diseases like depression
• Organ transplants like kidney or liver
• Obesity
• Thyroid disease

There are also certain pregnancy-related risk factors or conditions that develop during pregnancy that can make a pregnancy high risk:

• History of multiple miscarriages or pregnancy losses
• Pre-eclampsia, which is a condition related to high blood pressure in pregnancy
• Gestational diabetes (GDM)
• Gestational hypertension
• Abnormalities with the placenta
• Too much or too little amniotic fluid
• Infections like CMV, listeria, and toxoplasmosis 
• Multiple fetuses 
• Birth defects or genetic syndromes
• Poor growth of the fetus

Age is also a factor in determining whether a pregnancy is high-risk. Anyone over the age of 35 or under the age of 17 is considered at higher risk. (12, 14)

What Are The Signs & Symptoms of a High-Risk Pregnancy?

Patients should contact their providers if they experience any of the following symptoms:

• Vaginal bleeding
• Severe headaches that don’t go away
• Abdominal pain or cramping
• Fever
• Dizziness or fainting
• Extreme tiredness
• Heart palpitations or chest pain
• Decreased fetal movements
• Pain or burning with urination
• Changes in vision
• Sudden or severe swelling in the face, hands, or fingers
• Thoughts of harming oneself or the fetus

In some cases, there may be no symptoms associated with a high-risk pregnancy. (14)

What Causes a Pregnancy to be High-Risk?

Maternal health history and lifestyle choices, multiple fetuses, age, and complications that arise during the pregnancy itself can all make a pregnancy high-risk. Some of the factors causing a pregnancy to be high-risk, like genetics, for example, are outside of our control. Other factors contributing to high-risk pregnancy are modifiable. There are several things patients can do to help prevent a high-risk pregnancy (14, 44)

• Identifying and treating pre-existing medical conditions prior to conception so they are well-managed
• Avoiding drugs, alcohol, and toxic environmental exposures
• Maintaining a healthy body weight prior to pregnancy
• Eating a well-balanced diet 

Functional Medicine Labs to Support High-Risk Pregnancy Management

Functional medicine labs provide valuable information that allows practitioners to create a personalized plan for each patient to either prevent pregnancy complications from developing or manage already existing complications.

Initial Labs

Routine blood tests and screening tests are done in early pregnancy. A complete blood count (CBC) looks at red blood cells, white blood cells, and platelets to identify conditions like anemia or blood clotting issues. 

Blood type and Rh factor are ordered to identify possible Rh factor incompatibility. If the blood of a Rh+ fetus enters the blood of a Rh- negative mother, her body can make antibodies that can damage a Rh+ fetus’s red blood cells. 

Immunity for rubella is tested because rubella infection during pregnancy can cause birth defects. Hepatitis B, hepatitis C, tuberculosis (TB), HIV, and other sexually transmitted infections (STIs), including syphilis, gonorrhea, and chlamydia are also evaluated. 

A urinalysis and urine culture are collected to measure any glucose or protein in the urine or diagnose urinary tract infections. (38) 

Diabetes Screening

Pre-existing diabetes or GDM both cause high-risk pregnancies. GDM is typically diagnosed between weeks 24 and 28 weeks of pregnancy using a glucose challenge test. Measuring biomarkers associated with the diagnosis of diabetes, like fasting insulin, fasting glucose, and hemoglobin A1c can be used to give a more complete picture of blood sugar regulation.

Micronutrient Testing

Certain nutritional insufficiencies have been associated with conditions that make a pregnancy high-risk. For example, vitamin C, vitamin D, vitamin E, magnesium, and iron have been associated with the development of pre-eclampsia. Furthermore, vitamin D and antioxidant nutrients may play a role in the development of GDM. A Micronutrient Test measures 31 vitamins, minerals, and other nutrients like antioxidants, so individualized nutritional recommendations can be given if necessary.

Cardiovascular Testing

The changes that happen in pregnancy, like increased blood volume and heart rate, can introduce new cardiovascular issues or exacerbate pre-existing conditions. Cardiovascular disease, whether pre-existing or developing in pregnancy, is a significant cause of indirect maternal mortality. Women who experience potentially life-threatening complications from pregnancy are also more likely to develop cardiovascular disease in the future. The Heart Health Panel by Ayumetrix measures markers of vascular inflammation and cardiac stress to help monitor cardiovascular disease risk.

Environmental Toxins

Certain toxic environmental exposures have been linked to reproductive and developmental issues like infertility, miscarriage, preterm labor, and low birth weight. Some of these toxic exposures include cigarette smoke, phthalates, bisphenol-A (BPA), flame retardants, mercury, and pesticides. The Environmental Pollutants Profile by US BioTek measures toxin metabolites to help identify toxin levels present in urine.

Chronic stress

Chronic stress can lead to dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis and changes in cortisol levels. Stress, both prior to conception and during pregnancy, is associated with maternal and fetal health issues. Research has shown that higher maternal stress can cause changes to the cortisol awakening response (CAR) and diurnal rhythm of cortisol. Genova’s Adrenocortex Stress Profile measures both of these patterns to watch for changes in HPA axis activity that can promote stress-related complications in pregnancy.

Prenatal Screening

In women with higher risks, prenatal screening tests might be offered to determine whether the baby has a higher risk for a genetic abnormality. Such tests can include cell-free DNA blood test, nuchal translucency scan, and quad screen blood test. If any of these screening tests indicate a possible problem, more invasive options might be recommended, like chorionic villus sampling or amniocentesis.

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Conventional Treatment for a High-Risk Pregnancy

The management of high-risk pregnancies will vary depending on the reason the pregnancy has been diagnosed as high-risk. High-risk pregnancies can require more frequent follow-ups with OBGYNs, referrals to maternal-fetal medicine specialists, advanced ultrasound imaging, fetal monitoring, medications, at-home vital measurements, and referrals to other types of specialists. In some cases, early hospitalization, labor induction, or cesarean delivery may be necessary.

Functional Medicine Support for a High-Risk Pregnancy

In addition to the close maternal and fetal monitoring high-risk pregnancies receive, functional medicine treatments support the patient holistically to help reduce the occurrence of complications.

Nutrition Considerations For Supporting a High-Risk Pregnancy

A healthy diet in pregnancy, high-risk or otherwise, should focus on nutrient density because micronutrient needs increase in pregnancy, and mineral deficiency is associated with increased risks like anemia, hypertension, pre-eclampsia, poor fetal growth, labor complications, and mortality. The diet should emphasize whole foods, including fruits, vegetables, legumes, whole grains, and foods rich in omega-3 fatty acids like nuts, seeds, and fish, and limit highly processed foods. Research has shown that vegetable intake and adequate protein intake can play a role in fetal growth. High dietary intake of fiber can also help with issues like dyslipidemia and pre-eclampsia.

The Mediterranean diet follows the aforementioned suggestions and also demonstrated benefit research in reducing the risk for certain high-risk pregnancy conditions like GDM and preeclampsia.

Using Evidence-Based Supplements to Support a High-Risk Pregnancy

Supplement recommendations should be personalized based on patients’ needs and will vary depending on each patients’ circumstances. There are a few supplements that can be useful in multiple high-risk pregnancy conditions.

CoQ10

Women over the age of 35 have higher risks of complications in pregnancy, including chromosomal abnormalities. Egg quality can decrease as women age, increasing the risk of aneuploidies (abnormal number of chromosomes). Antioxidants, like CoQ10, show promise in reducing reproductive aging. Some research has shown that CoQ10 has reduced the rates of aneuploidies in older women undergoing in vitro fertilization (IVF). Although the pathogenesis of pre-eclampsia is not fully understood, inflammatory responses and lipid peroxidation have been implicated. Women with pre-eclampsia have shown lower levels of CoQ10, and CoQ10 supplementation can help to reduce the risk of developing pre-eclampsia.

Vitamin D

Vitamin D deficiency is a common occurrence in pregnancy and has been linked to maternal conditions like preeclampsia and gestational diabetes. It can also impact fetal growth. In women diagnosed with GDM, vitamin D supplementation can help with glycemic control, lowering fasting blood glucose, hemoglobin A1c, and fasting insulin levels.

Folic Acid

Folate and folic acid are important supplements for pregnancy because they can help to reduce the rate of neural tube defects. In both the general population and women at high risk for neural tube defects, it is recommended that 400 mcg of folic acid or folate be taken starting in the preconception period. Folic acid supplementation can also help to reduce the risk of preeclampsia.

Omega-3 Fatty Acids

Omega-3 fatty acids have been shown to prevent preterm labor, reduce the risk of preeclampsia, and support healthy birth weights. Omega-3 fatty acid supplementation in patients with GDM has been shown to decrease fasting blood glucose, reduce inflammatory markers, and reduce insulin resistance.

Complementary and Integrative Medicine Support for a High-Risk Pregnancy

Maternal stress and dysregulated HPA axis activity and cortisol levels can have an impact on both maternal and fetal health. Implementing stress management practices, like cognitive behavioral stress management (CBSM) and mindfulness practices, can help to reduce perceived stress and regulate cortisol levels.

Being diagnosed with a high-risk pregnancy can increase feelings of fear, guilt, shock, grief, frustration, worry, loneliness, and isolation, threatening a woman’s emotional well-being. Women diagnosed with high-risk pregnancies who incorporate more health-promoting behaviors, like stress management practices, report experiencing less stress. 

Some integrative medicine therapies like acupuncture, healing touch, and massage have shown promise in reducing anxiety levels in women who are hospitalized due to high-risk pregnancies and complications. Acupuncture has also been shown to reduce stress in pregnancy in general.

Exercise in pregnancy (if deemed safe by the medical provider) limits excess weight gain, reduces the risk of GDM, prevents hypertensive disorders, and reduces the occurrence of anxiety and depression.

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Summary

Women diagnosed with high-risk pregnancies may require additional care before, during, and after pregnancy. An integrative medicine approach provides the opportunity to support both the physical and emotional well-being of expecting mothers. Utilizing functional medicine labs and incorporating recommendations in relation to lifestyle factors like nutrition, stress management, and exercise can decrease the risk of complications for the mother or baby.