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High-risk pregnancy: when to ask for an MFM specialist

The short answer

  • “High-risk” means you or your baby need closer watching, not that something will go wrong. Many high-risk pregnancies end with a healthy parent and baby [1].
  • Risk can come from before pregnancy (like high blood pressure or diabetes), from this pregnancy (like twins or preeclampsia), or from a past one (like an earlier preterm birth) [1][2].
  • A maternal-fetal medicine (MFM) specialist is an OB-GYN with about 3 more years of training in complicated pregnancies [3][4].
  • You can ask for an MFM consultation. A good question is: “Would seeing MFM change anything about my care?”
  • Where you give birth matters too. Hospitals have levels of maternal and newborn care. Ask whether yours matches your risks [5].

What makes a pregnancy high-risk

These are common reasons. NIH and SMFM group them into health before pregnancy, problems in this pregnancy, problems in a past pregnancy, and concerns about the baby [1][3]. Having one doesn’t mean you need an MFM. It means it’s worth asking.

Health before pregnancy

  • high blood pressure, diabetes, or kidney disease;
  • heart disease, lung disease (like severe asthma), or a blood-clotting disorder;
  • autoimmune conditions like lupus, or a thyroid condition;
  • epilepsy, HIV, or another long-term condition;
  • a higher body weight (obesity), or being underweight;
  • a mental health condition, or substance use.

Age

  • being 35 or older, or a teenager [1][2].

This pregnancy

  • twins, triplets or more;
  • preeclampsia or gestational high blood pressure;
  • gestational diabetes;
  • problems with the placenta, such as placenta previa or placenta accreta;
  • a baby with a growth problem or a condition found on a scan or test;
  • bleeding, or signs of preterm labor.

Past pregnancies

  • a preterm birth, preeclampsia, a stillbirth, or several pregnancy losses;
  • a cesarean or other surgery on the uterus.

What an MFM specialist does

An MFM (also called a perinatologist) can [3]:

  • consult once: review your history, give your OB or midwife a plan, and hand you back;
  • co-manage: see you alongside your OB or midwife, often for detailed ultrasounds;
  • take over your care, if your pregnancy needs it.

MFMs often do the detailed anatomy scan (sometimes called a level II ultrasound), extra growth scans, and genetic counseling or testing [3].

When to ask for a referral

Ask your OB or midwife about an MFM consultation if:

  • you have any condition on the list above, and nobody has mentioned it;
  • you had a serious complication in a past pregnancy;
  • a scan or screening test came back abnormal;
  • you’re carrying more than one baby;
  • your symptoms or questions keep getting brushed off.

You can ask at any point. Earlier is better, while there’s more time to act on a plan.

How to speak up

You know your body. These questions help get you heard:

  • “What’s my risk, and what are we doing about it?”
  • “Would seeing MFM change anything about my care? If not, why not?”
  • “What symptoms should make me call you, and what should make me go straight to the hospital?”
  • “Does the hospital where I’ll give birth have the right level of care for me and my baby?”
  • “Can I get a copy of my records and test results?”

If you still feel unheard, you can ask for a second opinion. Write symptoms down with dates and times, and bring someone with you who can speak up too.

Two things worth asking about

Low-dose aspirin. If you’re at high risk of preeclampsia, the US Preventive Services Task Force recommends low-dose aspirin (81 mg a day) after 12 weeks of pregnancy [6]. Don’t start it on your own. Ask whether it’s right for you.

The level of your hospital. ACOG and SMFM describe four levels of maternal care, from basic care to centers for the most complex conditions [5]. NICUs are graded in levels too. If your baby may come early or need special care, ask whether your hospital can handle it, or whether you should plan to give birth somewhere else [5].

Warning signs, for everyone

Get medical care right away for: a headache that won’t go away or gets worse, dizziness or fainting, vision changes, a fever of 100.4°F or higher, extreme swelling of the face or hands, trouble breathing, chest pain or a racing heart, severe belly pain, bleeding or fluid leaking, your baby moving less, or thoughts of harming yourself [7]. Say you’re pregnant, and say how far along. For an emergency, call 911.

Insurance and access

  • An MFM visit often needs a referral, and sometimes prior approval. Ask your OB’s office to send it, then call your plan to confirm.
  • If there’s no MFM near you, ask about telehealth consultations, or a specialist at a regional hospital who can work with your local OB.

Sources

  1. NIH, Eunice Kennedy Shriver National Institute of Child Health and Human Development, “What are some factors that make a pregnancy high risk?” nichd.nih.gov
  2. American College of Obstetricians and Gynecologists, “Having a Baby After Age 35” and related patient FAQs. acog.org
  3. Society for Maternal-Fetal Medicine, “What is a Maternal-Fetal Medicine (MFM) Subspecialist?” (patient sheet, 2025). smfm.org
  4. American Board of Obstetrics and Gynecology, “Maternal-Fetal Medicine” subspecialty certification. abog.org
  5. American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine, Obstetric Care Consensus No. 9, “Levels of Maternal Care” (2019). acog.org
  6. US Preventive Services Task Force, “Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Preventive Medication” (2021). uspreventiveservicestaskforce.org
  7. CDC, Hear Her campaign, “Urgent Maternal Warning Signs.” cdc.gov

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