High-Risk Pregnancies in India: Contributing Factors
A high-risk pregnancy is one in which the health or life of the mother, fetus, or both is threatened due to certain medical, environmental, or social factors.
In India, the burden of high-risk pregnancies (HRP) is significantly increasing, posing serious challenges to safe motherhood.
Current Trends
- Nearly 45–50% of pregnant women in India are now classified as high-risk.
- HRPs contribute to over 70% of maternal and perinatal deaths, according to the Ministry of Health & Family Welfare (MoHFW) and NITI Aayog maternal health reports (2024).
- The rise is linked to lifestyle diseases, delayed motherhood, poor nutrition, and uneven access to antenatal care.
What Makes a Pregnancy “High-Risk”?
A pregnancy is termed high-risk when one or more of the following are present:
- Pre-existing medical conditions (e.g., diabetes, hypertension, thyroid disorders)
- Pregnancy-related complications (e.g., pre-eclampsia, gestational diabetes, placenta previa)
- Lifestyle or environmental factors (e.g., malnutrition, pollution, heat exposure)
- Socioeconomic or demographic risks (e.g., adolescent or advanced maternal age, poor access to healthcare)
Contributing Factors in India
1. Advanced Maternal Age & Delayed Pregnancy
- More Indian women are postponing childbirth beyond 30–35 years, especially in urban areas.
- Fertility treatments and late conception increase the risk of:
- Chromosomal abnormalities (like Down Syndrome)
- Pre-eclampsia
- Gestational diabetes
- Caesarean deliveries
- Postpartum complications
According to a 2025 study (All India Institute of Medical Sciences), pregnancies after 35 years have a 2.5× higher risk of complications.
2. Rising Obesity and Sedentary Lifestyle
- Urbanization and poor dietary habits have led to obesity becoming a major maternal risk.
- Obese women face higher chances of:
- Hypertension & pre-eclampsia
- Gestational diabetes
- Prolonged labour or surgical delivery
- Postpartum hemorrhage (PPH)
A study by FOGSI (2024) found 28% of Indian urban pregnant women were overweight or obese before conception.
3. Hypertension and Pre-eclampsia
- High blood pressure is increasingly common due to stress, obesity, and poor diet.
- Hypertensive disorders remain a top cause of maternal death in India, contributing to around 15% of cases.
- Many women are unaware of their BP issues before pregnancy, leading to late diagnosis.
4. Diabetes and Gestational Diabetes Mellitus (GDM)
- India is known as the “diabetes capital” — and this affects pregnancy too.
- Around 1 in 6 pregnancies in India now involves GDM.
- Risks include:
- Macrosomia (very large baby)
- Preterm labour
- Stillbirths
- Long-term diabetes risk for both mother and child
The 2024 ICMR-National Diabetes Survey shows rising GDM prevalence in both rural and urban India, due to diet and sedentary lifestyle.
5. Malnutrition & Anaemia
- Iron deficiency anaemia (IDA) affects nearly 50–60% of pregnant women in India (NFHS-5).
- Consequences include:
- Preterm birth
- Low birth weight
- Fatigue and delayed recovery
- Increased risk of hemorrhage during delivery
Despite national iron supplementation programs, poor compliance and dietary gaps persist.
6. Teenage Pregnancy
- India still reports a teen pregnancy rate of ~6–7%, particularly in rural and tribal regions.
- Teenage mothers face:
- Higher maternal mortality
- Preterm delivery
- Poor fetal growth due to undernutrition
- Social stigma and lack of antenatal care
Adolescent pregnancies are often unplanned and lack medical supervision.
7. Short Birth Intervals
- Many women conceive within 18 months of a previous birth, which doesn’t allow full recovery.
- This leads to:
- Nutritional depletion
- Anaemia
- Preterm or low-weight babies
- Family planning gaps and cultural expectations contribute heavily to this risk.
8. Environmental & Climate Factors
- Rising temperatures, air pollution, and heatwaves are emerging as new maternal risks.
- Studies from 2025 link extreme heat exposure to:
- Preterm labour
- Hypertension
- Stillbirth
- Women working in outdoor sectors (agriculture, construction) are most vulnerable.
9. Limited Access to Quality Antenatal & Delivery Care
- Rural India still faces:
- Shortage of trained obstetricians and nurses
- Poor transportation to hospitals
- Lack of emergency obstetric services (blood transfusion, C-section facilities)
- Delays in recognizing or managing complications are major contributors to maternal deaths.
The “Three Delays” Model (delay in decision, reaching care, and receiving treatment) remains a key challenge.
10. Mental Health and Social Factors
- Stress, domestic violence, and depression are under-recognized but potent risk factors.
- Maternal mental health directly affects birth outcomes and postpartum recovery.
- Stigma often prevents women from seeking psychological support.
Consequences of High-Risk Pregnancies
| For the Mother | For the Baby |
|---|---|
| Hypertension / eclampsia | Preterm birth |
| Hemorrhage | Low birth weight |
| Infection / sepsis | Stillbirth |
| Postpartum depression | Developmental delays |
| Need for C-section | Neonatal intensive care admission |
National Efforts & Programs
India has launched several initiatives to reduce HRP burden:
- LaQshya (Labour Room Quality Improvement Initiative) – improving labour room standards.
- Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) – free monthly checkups for pregnant women.
- Anemia Mukt Bharat (AMB) – combating iron deficiency.
- Janani Suraksha Yojana (JSY) – incentivizing institutional deliveries.
- POSHAN Abhiyaan – improving maternal and child nutrition.
These programs have helped increase institutional delivery rates to over 89% (NFHS-5), but HRP management remains uneven across states.
Preventive & Management Strategies
For Women:
- Early registration and antenatal check-ups (ideally before 12 weeks).
- Balanced diet rich in protein, iron, calcium, and vitamins.
- Regular exercise (as advised).
- Strict blood pressure and sugar monitoring.
- Avoid alcohol, tobacco, and excessive stress.
- Adequate spacing between pregnancies (minimum 2 years).
For Healthcare Providers:
- Identify high-risk cases early using HBP & GDM screening.
- Ensure referral linkages for emergency obstetric care.
- Conduct awareness sessions in rural areas about nutrition, danger signs, and care.
For Policymakers:
- Strengthen rural health infrastructure (ambulances, blood banks, skilled birth attendants).
- Include climate resilience in maternal care programs.
- Improve data systems to track HRP outcomes at state and district levels.
Expert Insight
“Nearly half of India’s maternal deaths are preventable with early risk detection and quality antenatal care.”
— Dr. Ranjana Kumari, Centre for Social Research, 2025
“Urban obesity and rural malnutrition together are reshaping the risk map of Indian pregnancies.”
— Indian Journal of Obstetrics & Gynecology, 2024
Summary
| Category | Examples / Consequences |
|---|---|
| Medical | Hypertension, diabetes, anaemia, thyroid disorders |
| Lifestyle | Obesity, poor diet, lack of exercise |
| Demographic | Teen or advanced-age pregnancy |
| Environmental | Heat, pollution, physical stress |
| Socioeconomic | Low income, poor access to care, short birth spacing |
Early diagnosis, healthy lifestyle, and equitable access to care are the keys to reducing high-risk pregnancies and ensuring safe motherhood in India.