Johns Hopkins All Children's Hospital

High-Risk Pregnancy

If you're experiencing a high-risk pregnancy, you and your baby may require specialized care. Get information on what to expect during pregnancy and find programs and services that can provide the right level of care for you and your baby.

Mothers with a high-risk pregnancy need informational and emotional support throughout pregnancy, delivery and follow-up care. It is important moms with high-risk pregnancies have the right level of care that provides a seamless plan for mother and baby.

Clinics and Programs

Our continuum of care model means that we provide the full spectrum of care for women and babies. This includes specialized care for mothers with high-risk pregnancies and fetuses at risk for complications in utero and neonatal care for critically ill or premature newborns. 

Fetal Care Program

Fetal Care Program

The Fetal Care Program at Johns Hopkins All Children’s Hospital offers a coordinated, family-centered approach to the diagnosis and treatment of fetal anomalies that brings perinatal, neonatal and pediatric specialists to the patient.

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Information for Parents

About our NICU

Our NICU has a Level IV designation from the American Academy of Pediatrics—the highest level available—and is dedicated to infants who need the most specialized care. Our NICU resources include a breast milk depot and donor milk bank and lactation education and support.

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Tour the NICU

Neonatal Follow-up Program

Our innovative follow-up clinics and programs bring together specialists in areas such as cardiac disease, neonatal abstinence syndrome and intestinal rehabilitation, allowing them to focus on the critical early development of children with these conditions. 

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Benefits of Breastmilk for Low-weight Preemies

Mother’s milk is more than a source of nutrition for babies—it is rich in hundreds of molecules that have a positive effect on health. These benefits occur not only in infancy but last a lifetime.

What to Expect for Your 20-Week Ultrasound

The 20-week ultrasound is often the most anticipated ultrasound during pregnancy. The purpose of this ultrasound is to look at the fetus’ anatomy from head to toe to make sure all is normal, and a perinatologist ­­— a maternal-fetal medicine specialist who can manage health concerns of the mother and fetus before, during and shortly after pregnancy — will review the scan. The anatomy screen will give a detailed look at the baby’s:

  • Face
  • Limbs
  • All four chambers of the heart
  • Spine
  • Brain
  • Stomach
  • Kidneys
  • Gender
  • Everything is measured to make sure baby is growing at the right rate for his/her gestational age.
  • The ultrasound tech will also look at the uterus, placenta and amniotic fluid.

What Happens if Something Looks Different?

From time to time, something unusual is seen during the screening. If this happens, further testing might be needed to ensure a safe and healthy care plan for mom and baby. If there is a high-risk indication, then a more detailed ultrasound is performed with the perinatologist, and if needed, the perinatologist might recommend follow-up care or referrals to additional specialists at this time.

How to Prepare for the 20-Week Ultrasound

Mom does not need to specifically prepare for the ultrasound. The screening can take up to 45 minutes and possibly longer if the baby isn’t in the right position.

Diagnostic Testing

Some common diagnostic testing may be offered in combination with a fetal ultrasound and maternal blood testing. Some of the diagnostic testing, such as amniocentesis and chorionic villus sampling (CVS), can be used to help determine chromosome and genetic concerns. If you and your physician decide diagnostic testing is needed, your physician will discuss the best options for you and your baby.

Gestational Diabetes

All moms will be tested for gestational diabetes at some point during weeks 26-28 of pregnancy. During this prenatal visit, mom will drink a sweet drink one hour before blood is drawn to see if she is producing enough insulin. If the test comes back positive for gestational diabetes, mom should maintain her blood sugar levels by:

  • Diet and exercise
  • Closely monitor mom and baby

If treated appropriately, women diagnosed with gestational diabetes can have healthy babies. Gestational diabetes should resolve after delivery, but further evaluation may be needed.

Symptoms of Gestational Diabetes

  • Frequent urination
  • Excessive thirst
  • Increased sugar in blood or urine

Preeclampsia (High Blood Pressure During Pregnancy)

Preeclampsia is a pregnancy condition associated with high blood pressure and protein in the urine and usually occurs after the 20th week of pregnancy. Your doctor will check for any signs of preeclampsia during prenatal visits. Bloodwork is used to determine a diagnosis for preeclampsia, along with symptoms the patient may have. If preeclampsia is detected, you and your doctor can work together to ensure an appropriate plan of care to prevent complications for you and your baby.

Symptoms of Preeclampsia

There may be no symptoms, but symptoms include:

  • Blurred vision
  • Headaches
  • High blood pressure
  • Sudden weight gain (greater than normal)
  • Swelling in the legs

How is High Blood Pressure Treated?

If needed, high blood pressure can be treated with medications, and your physician might discuss the option to deliver the baby earlier versus continued preeclampsia symptoms. Once the baby is delivered, preeclampsia often disappears but further evaluation may be needed.

A high-risk pregnancy success story:


Sylvia thought she would never get pregnant. She had miscarriages in 2004 and 2006 and faced much heartache and stress in trying to become a mother. Sylvia has a rare antibody in her blood called PP1PK that can cause miscarriages or stillbirths. When she learned she was pregnant again, her doctor discovered the antibody and referred her to Johns Hopkins All Children’s Fetal Care Program designed to help women like Sylvia who have challenging pregnancies.  

Information on high-risk pregnancy

Dr. Karen Raimer Relies on Personal Experience to Help Mothers through Difficult Pregnancies

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Comprehensive Model for High-risk Pregnancies

Guiding expectant mothers through challenges and on to a successful birth often requires expertise and collaboration.

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Early Birth, Extraordinary Care

Kassi was born prematurely at 31 weeks with Down syndrome and faced heart issues, breathing problems, kidney disease and feeding issues. The Johns Hopkins All Children’s Fetal, Maternal & Neonatal Institute managed and coordinated her early care, working to build her strength and size so she could thrive on her own.

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