In Malaysia, high-risk pregnancies are becoming an increasingly common aspect of modern maternal healthcare, as more women embark on motherhood later in life, often with underlying conditions such as obesity, diabetes or previous pregnancy complications that heighten medical risks during pregnancy and childbirth.
In more serious cases, complications such as foetal growth restriction, premature birth, severe hypertension, postpartum haemorrhage and neonatal complications can place both mother and baby at significant risk if not detected early.
According to Dr Sharifah Najwa Syed Amin Husaini, the profile of pregnancy itself has gradually changed alongside delayed childbearing, lifestyle shifts and the growing burden of chronic disease among younger adults.
“We are seeing more women delaying childbirth for personal and career reasons, and that naturally changes the risk profile we manage in clinic,” she said in a recent interview with Bernama.
Clinicians are also recognising that many pregnancy risks do not begin during pregnancy itself but are often shaped long before conception through a woman’s metabolic health, medical history, lifestyle and reproductive planning. As a result, modern obstetric care has increasingly shifted from reacting to complications during pregnancy to identifying risks earlier and preparing women for pregnancy in advance.
WHY HIGH-RISK PREGNANCIES ARE ON THE RISE
Dr Sharifah Najwa explained that a high-risk pregnancy refers to a situation where either the mother, the baby or both face an increased likelihood of complications before, during or after delivery. Such risks may arise from chronic medical conditions, pregnancy-related complications, foetal abnormalities or multiple overlapping factors.
One of the biggest contributing factors is maternal age.
“More women are choosing to delay childbirth until their mid-30s or later due to career progression, financial planning or personal readiness. While many pregnancies at this age remain healthy, the physiological risk profile naturally changes over time.
“With advanced maternal age, we see a natural increase in conditions like hypertension and diabetes. But it does not mean the pregnancy will necessarily be complicated, it simply means closer monitoring is needed,” she said.
Fertility decline after the age of 35 has also contributed to the growing use of assisted reproductive technologies such as in-vitro fertilisation (IVF). While IVF has enabled many couples to conceive successfully, these pregnancies often involve patients with pre-existing fertility or medical concerns, requiring closer monitoring from the outset.
Advanced maternal age is also associated with higher risks of miscarriage, chromosomal abnormalities and placental complications, while paternal age may similarly contribute to certain genetic risks.
Alongside age, obesity and diabetes have emerged as some of the most common conditions affecting pregnant women in Malaysia. Population studies show that more than half of Malaysian women are either overweight or living with obesity, significantly increasing the risk of gestational diabetes, hypertensive disorders and delivery complications.
According to her, clinical trends at ParkCity Medical Centre reflect this broader shift. Of the 217 deliveries recorded at the centre in 2025, about one-third involved mothers aged above 35 who showed a tendency towards high-risk pregnancies, while gestational diabetes and pregnancy-induced hypertension remained among the more frequently encountered complications.
She noted that in many cases, these conditions are only detected during pregnancy itself when routine antenatal screening reveals previously undiagnosed metabolic disease. At the same time, maternal risk is not confined to older mothers alone. Teenage pregnancies, particularly among girls under 18, also carry heightened medical and social risks, including nutritional deficiencies, premature delivery and inconsistent antenatal care.
THE HIDDEN RISKS BEFORE PREGNANCY
One of the most overlooked realities in maternal healthcare is that pregnancy outcomes are often shaped long before conception. Specialists are increasingly emphasising the importance of pre-pregnancy or preconception care, particularly for women with underlying conditions such as diabetes, hypertension or previous complicated pregnancies.
According to Dr Sharifah Najwa, many women still perceive preconception counselling as something needed only for fertility issues, when in reality it plays an important role in identifying silent health risks before pregnancy occurs.
“A common issue we see is patients stopping their medication without consulting a doctor. While the intention may be good, the outcome can sometimes be harmful if the condition becomes uncontrolled,” she said.
Fear surrounding medication use during pregnancy, often fuelled by misinformation on social media or informal advice, has caused some women to abruptly discontinue essential treatment without medical supervision. However, she stressed that many medications can either be safely continued during pregnancy or adjusted through proper medical planning.
She also encouraged couples to begin optimising their health at least three to six months before attempting pregnancy, especially since conditions such as obesity and chronic disease often require sustained management rather than short-term changes. This includes nutritional assessment, weight management, smoking cessation, folic acid supplementation, chronic disease control and lifestyle modifications for both partners.
Contraception, meanwhile, is increasingly being viewed not only as family planning but also as part of medical risk reduction. For women with previous complicated pregnancies or poorly controlled medical conditions, proper spacing between pregnancies allows time for recovery and health optimisation before conceiving again.
“That gap between pregnancies can really make a difference,” she advised.
TECHNOLOGY AND EARLY SCREENING CHANGING OUTCOMES
Modern obstetrics has increasingly shifted towards early detection and predictive care, enabling specialists to identify potential complications long before they become critical. At ParkCity Medical Centre, management of high-risk pregnancies typically begins with early risk stratification through detailed medical history taking, blood investigations and ultrasound assessments.
One of the most widely used tools today is Non-Invasive Prenatal Testing (NIPT), a blood test that analyses foetal circulating in the mother’s bloodstream to screen for chromosomal abnormalities such as Down syndrome with more than 99 per cent accuracy.
“From as early as nine weeks, we can detect foetal DNA in the mother’s bloodstream. This allows us to identify certain conditions much earlier than before,” Dr Sharifah Najwa explained.
Although NIPT has become increasingly accessible in Malaysia’s private healthcare sector, access in some settings remains limited by cost. First trimester screening has also become more sophisticated through the use of biomarkers such as Placental Growth Factor (PLGF), a blood marker used to identify women at higher risk of developing preeclampsia, a potentially dangerous hypertensive disorder affecting both mother and baby.
Advanced ultrasound imaging has likewise enabled earlier and more detailed detection of fetal structural abnormalities, placental disorders, growth restriction and complications involving multiple pregnancies.
“In selected specialised centres, foetal interventions such as intrauterine blood transfusions and procedures for complicated twin pregnancies can also improve survival and pregnancy outcomes in highly complex cases,” she added.
Preventive maternal healthcare has also expanded beyond pregnancy monitoring alone. Vaccinations such as influenza, the tetanus, diphtheria and pertussis (Tdap) vaccine, and the respiratory syncytial virus (RSV) vaccine are increasingly recommended during pregnancy to provide newborns with early protection against severe infections during their first few months of life.
SPECIALIST CARE AND FINANCIAL REALITIES
High-risk pregnancies are rarely managed by a single specialist. Depending on the complexity of the case, care often involves coordination between obstetricians, physicians, endocrinologists, anaesthetists, neonatologists, nutritionists and paediatric teams.
At ParkCity Medical Centre, obstetricians typically serve as the central coordinators throughout the pregnancy journey, overseeing referrals, monitoring progress and aligning treatment decisions across multiple disciplines.
“No single specialist manages these pregnancies in isolation. It has always been a team effort,” Dr Sharifah Najwa pointed out.
She added that the availability of a dedicated Neonatal Intensive Care Unit (NICU) and on-site neonatologists at the centre played an important role in managing high-risk pregnancies, particularly in cases involving premature delivery or babies requiring immediate specialised care after birth.
However, despite advances in specialist care and technology, financial challenges remain a significant concern for many families seeking treatment in private healthcare settings. Many advanced screenings, follow-up investigations and specialised procedures are not fully covered by insurance, particularly for pregnancy-related care.
“There needs to be transparency in the cost structure so patients can plan properly,” she said, adding that preventive services such as contraception and pre-pregnancy optimisation are still frequently overlooked within insurance coverage despite their important role in reducing future pregnancy complications.
TOWARDS A MORE PREVENTIVE MATERNAL HEALTHCARE SYSTEM
As Malaysia moves towards becoming an ageing nation, Dr Sharifah Najwa believes maternal healthcare must adapt to pregnancies that are increasingly medically complex and require earlier intervention.
She stressed that stronger collaboration between the public and private healthcare sectors would be essential to ensure high-risk mothers can access specialist care, advanced screening and continuity of monitoring regardless of where they first seek treatment.
“What we really need is a more seamless referral pathway between public and private healthcare,” she said, adding that patients should be able to access specialised services without disruption to their care.
She also noted that formal partnerships between public institutions and private laboratories or hospitals could help expand access to specialised services such as advanced genetic screening and high-end fetal imaging.
Beyond clinical care, she highlighted the need for stronger national data systems. While Malaysia already maintains a National Obstetric Registry (NOR), more comprehensive tracking of high-risk pregnancies could improve long-term healthcare planning and maternal outcome monitoring.
At the same time, she said, maternal healthcare should increasingly be viewed through a broader ‘life-course approach’ that prioritises health optimisation long before pregnancy begins. This includes earlier intervention for obesity, hypertension, nutrition and reproductive health awareness.
She believes pre-pregnancy counselling and preventive maternal care should become more widely integrated across both public and private healthcare systems, particularly as delayed childbearing and chronic health conditions become more common among Malaysians.
“With proper planning, early detection and the right support system, many women can still go through pregnancy safely and achieve good outcomes for both mother and baby,” she said.
