Neonates at Risk: Understanding the Impact of High-Risk Pregnancies on Neonatal Health

Abstract

High-risk pregnancies (HRPs) constitute a significant global health issue due to their strong association with increased maternal and neonatal morbidity and mortality. Although pregnancy is generally characterized by positive expectations, the presence of maternal comorbidities, gestational complications, or adverse socioeconomic and environmental conditions can markedly elevate the probability of unfavorable outcomes. HRPs contribute disproportionately to complications such as preterm birth, fetal growth restriction, low birth weight, and congenital anomalies, which are key determinants of neonatal mortality and long-term developmental and health challenges. A broad spectrum of risk factors as well as insufficient prenatal care, underscores the complex nature of HRPs. These conditions necessitate a multidisciplinary management approach encompassing early risk identification, continuous monitoring, and individualized interventions. The neonatal prognosis in such contexts is strongly influenced by gestational age at delivery, birth weight, the standard of neonatal care, and the underlying etiological factors driving preterm or complicated deliveries. Preventive strategies including comprehensive prenatal screening, systematic antenatal follow-up, and timely referral to specialized perinatal care centers are essential for reducing the burden of HRPs. Furthermore, addressing social determinants of health-such as low socioeconomic status and limited access to healthcare-is critical for optimizing maternal and neonatal outcomes. This review consolidates current evidence on the epidemiology, etiological factors, and clinical implications of high-risk pregnancies, emphasizing the necessity of an integrative, preventive, and multidisciplinary framework to mitigate adverse neonatal outcomes and improve long-term health trajectories.

Keywords: SARS-CoV-2 infection; congenital infections; fetal growth restriction; gestational diabetes mellitus; high-risk pregnancies; neonates; preeclampsia; prematurity; substance use.

Figure 1

Visual summary of the risk factors that contribute to high risk pregnancies. PT: preterm, IUGR: intrauterine growth restriction, IVH: intraventricular hemorrhage, NEC: necrotizing enterocolitis, TTTS: Twin-to-Twin Transfusion Syndrome, TAPS—Twin Anemia-Polycythemia Sequence, TRAP—Twin Reversed Arterial Perfusion sequence. Created in BioRender. L., A. https://BioRender.com/p2iztwi (accessed on 14 May 2025).

Figure 2

Visual summary of congenital viral infections and SARS-CoV-2 exposure during pregnancy. CMV: cytomegalovirus, CRS: congenital rubella syndrome, HSV: herpes simplex virus, HAV: hepatitis A virus, HBV: hepatitis B virus, HCV: hepatitis C virus, HIV: human immunodeficiency virus, AIDS: Acquired Immunodeficiency Syndrome, HEU: HIV exposed uninfected, ZVS: zika virus syndrome, LBW: low birth weight. Created in BioRender. L., A. https://BioRender.com/ymqw7ev (accessed on 5 June 2025).