A high-risk pregnancy is one in which the woman has a problem or condition, either physiologic, social, or emotional, that threatens maternal or fetal health and produces an increased chance of morbidity or mortality. Murphy and Robbins describe two major types of high-risk pregnant women: those who have chronic conditions that predispose them to problems during pregnancy, and those who develop an unanticipated complication during a previously normal pregnancy.1Women who know themselves to be at risk because of a chronic condition (such as diabetes mellitus, systemic lupus erythematosus, or chronic hypertension) may have expected the need for close supervision during their pregnancy, including additional clinic visits and possible hospitalization. For these women, being hospitalized or put on home care may not be associated with a particularly high level of crisis, although they may be anxious about the impact of their condition on fetal outcome.2The best predictor of adaptation to high-risk pregnancy in women with a pre-existing health problem is their adaptation to the chronic condition. Conversely, women who are unexpectedly hospitalized or placed on bed rest at home for complications that arise during pregnancy usually experience a high level of crisis. This is especially true if the condition threatens the life and well-being of the mother and/or fetus, such as preterm labor or antepartum hemorrhage.1These women are not prepared for development of a complication and often react with feelings of anger, disbelief, fear, and anxiety.3Feelings of blame, guilt, or failure can disrupt family equilibrium, and make the pregnancy even more difficult. These women need time to grieve for the loss of a formerly healthy self and for hopes of a normal pregnancy.1A high-risk pregnancy can be very stressful for the pregnant woman and her family, resulting in a significant psychosocial impact. High-risk pregnancy imposes many restrictions on the pregnant woman, including changes in her eating habits, sleeping, homemaking, child rearing, sexuality, and social and recreational activities, as well as disruptions to work-related activities or career plans. These changes also affect the living patterns of other members of the family.4The usual processes of adaptation to pregnancy are disrupted because the woman must cope with altered developmental tasks created by the stress of her high-risk pregnancy and the uncertainty of attaining motherhood.5This article will review research on the psychosocial impact of high-risk pregnancy on women undergoing antepartum hospitalization or antepartum home care. The implications for care of high-risk pregnant women and their families will be discussed.
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