High risk pregnancy in Singapore: who it applies to and how your care changes

SGH calls your pregnancy high risk when any condition raises the chance of a problem for you, your baby or both. In Singapore that covers older mothers and women with heart, kidney or diabetic conditions. Women who've had late or repeated losses are on the list too. It means closer checks and a bigger care team. The most useful things you can do are to plan early and keep your medicines going, then learn where to go if something changes.

What to do if your pregnancy is high risk, step by step

1. Book a pre-pregnancy check if you're still planning. KKH's STORK Centre has an Obstetric Pre-Pregnancy Counselling Clinic, and our trying to conceive guide has a checklist.
2. Give your gynae a full list of your conditions and medicines, even the ones another specialist manages. Bring the boxes if that's easier. KKH asks women with diabetes, high blood pressure or regular medication to speak to their doctor for advice, and our first gynae visit guide has more on that first appointment.
3. Keep taking your prescribed medicines until you've spoken to your doctor. SingHealth says coming off medicine that keeps you well would put your baby at risk. Our guide to safe medicine during pregnancy has more.
4. Ask your gynae or polyclinic doctor whether you need a specialist clinic. KKH's STORK Centre takes referrals from healthcare professionals.
5. Keep every appointment, even on days you feel well. SingHealth notes that pre-eclampsia can develop without obvious signs, and KKH says the blood pressure and urine checks at each visit help pick it up.
6. Do home checks if your team asks for them. If you're given a blood pressure monitor or a glucose meter, ask which readings mean you should call.
7. Find out where your hospital wants you to go in an emergency, well before you need it. At KKH, it's the Delivery Suite on Level 2 of the Women's Tower from 22 weeks, and the Urgent O&G Centre in Basement 1 before 22 weeks.
8. Track your baby's movements once you feel them. KKH says to come in if your baby moves less than usual, so don't hold it for your next check-up. The baby kick counter helps you keep count.

What makes a pregnancy high risk

SGH's list starts with older mothers. It adds women with heart, kidney or diabetic conditions before pregnancy, women with repeated or late pregnancy losses, and babies found to have an abnormality. Twins and triplets count too, and an SGH doctor says fertility treatment makes them more common. KKH's Dr Serene Thain adds that obesity raises the chance of complications. The pregnancy weight gain calculator shows a healthy gain for your BMI.

KKH's Assoc Prof Tan Lay Kok gives the same pre-pregnancy advice for high blood pressure, heart disease, asthma, kidney conditions, epilepsy and rheumatic conditions. He says it's best to have them in remission or well controlled before you conceive. KKH also runs clinics for thyroid disorders in pregnancy. STORK's pre-pregnancy clinic sees women with autoimmune conditions as well.

A past caesarean has its own planning, which our VBAC guide covers. Carrying more than one baby? See twins pregnancy in Singapore.

What extra care usually involves

KKH says a healthy woman has around 8 to 10 antenatal visits. Your blood pressure and urine are checked at every one. A high risk pregnancy adds more on top. KKH's maternal fetal medicine department offers an early anatomy scan at 15 to 16 weeks in high risk pregnancies, plus Doppler scans to check on the baby. Its team includes obstetricians, clinical nurses, genetic counsellors and neonatologists. Prof Tan says women with a high risk pregnancy should be cared for by a multi-disciplinary team like this one.

Your own plan comes from your team. Our guides on gestational diabetes, pre-eclampsia, thyroid problems in pregnancy and a big baby go deeper on each.

Where high risk care happens in Singapore

Your first appointment can start at a polyclinic, a family clinic or KKH itself, KKH says. If you need more, your doctor refers you on.

KKH's STORK Centre has 10 clinics on the KKH campus, led by its Department of Maternal Fetal Medicine. They cover diabetes, other medical disorders, preterm birth, twins, small babies and pre-pregnancy counselling. SGH runs a Centre for High-Risk Pregnancies with eight clinics, and NUH has its own division of maternal fetal medicine.

These centres don't see every high risk pregnancy. Dr Thain says STORK takes the most high risk patients, while general obstetrics clinics look after others. For KKH appointments, SingHealth lists Central Appointments at 6294 4050. Our prenatal check-ups and scans guide sets out the routine visits.

Pregnant after 35 in Singapore

KKH's Dr Serene Thain uses over 35 as the line for advanced maternal age. She lists a higher chance of miscarriage, Down syndrome in the baby, gestational diabetes and high blood pressure in pregnancy. She also says pre-pregnancy counselling and getting your health in shape may help reduce some of these risks.

Screening for Down syndrome is your choice. KKH's maternal fetal medicine department offers the first trimester screen, NIPT and a second trimester quadruple test. Our 9 weeks pregnant guide compares them.

Still trying? Dr Thain suggests a fertility specialist or a pre-pregnancy assessment at a centre like KKH if you're over 35 and not pregnant after six months of trying.

When to see a doctor

Go to your delivery hospital, or call your gynae's clinic, for any of these. Each sign is a reason to get checked by a doctor, who will work out the cause.

• Your baby moving less than usual. KKH lists this as a reason to come in, and SingHealth says a persistent drop needs help.
• Vaginal bleeding, or fluid gushing or trickling from the vagina (KKH).
• A fever (KKH).
• A severe headache, changes in your vision or tummy pain (KKH). SingHealth also lists dizziness and pain in the upper abdomen among pre-eclampsia signs, along with nausea and vomiting.
• Regular contractions before 37 weeks, which SingHealth calls preterm labour.
• Chest pain or breathlessness that comes and goes. The NHS says to get an urgent appointment, as these can be signs of a heart or lung problem.
• Sudden chest pain that spreads to your arms, back, neck or jaw. The NHS says this could be a heart attack. In Singapore, call 995.
• A seizure. NNI says to call 995 or go to an emergency department if the person is pregnant.
• Home blood pressure or glucose readings above the limits your own team set. Call the clinic that looks after your pregnancy.

At KKH, go to the Delivery Suite on Level 2 of the Women's Tower from 22 weeks, or the Urgent O&G Centre in Basement 1 before 22 weeks. Booked at SGH or NUH? Our premature labour signs guide lists their routes. For an emergency, call 995.

Frequently asked questions

Is there a high risk pregnancy clinic in Singapore?

Yes. KKH's STORK Centre, SGH's Centre for High-Risk Pregnancies and NUH's division of maternal fetal medicine all care for high risk pregnancies. STORK takes referrals from healthcare professionals, so ask your gynae or polyclinic doctor. Some high risk pregnancies are looked after in general obstetrics clinics instead.

Is being pregnant after 35 in Singapore high risk?

SGH counts older mothers among high risk pregnancies. KKH's Dr Serene Thain draws the line for advanced maternal age at over 35. She says seeing a gynae before you try, and getting your health in shape, may help reduce some of the risks.

What is an advanced maternal age pregnancy?

It's a pregnancy in a woman over 35, as KKH's Dr Thain uses the term. The chance of miscarriage, Down syndrome, gestational diabetes and high blood pressure is higher. Screening is a choice, and KKH offers the first trimester screen, NIPT and a quadruple test.

Can I have a healthy pregnancy with existing conditions?

NNI says women with epilepsy can become pregnant and have healthy children. Dr Thain says women on thyroid medicine have good chances of pregnancy when their thyroid levels stay normal. For conditions such as high blood pressure, asthma or kidney disease, Prof Tan's advice is to get them well controlled before you conceive.

Should I stop my medicine when I find out I'm pregnant?

No, not on your own. Keep taking it until you've spoken to your doctor, because SingHealth says coming off medicine that keeps you well would put your baby at risk. The NHS gives the same advice for heart medicines. Your doctor may review what you take, and any change is a decision you make together.