The best predictor of problems in a pregnancy is the presence or absence of problems in previous pregnancies. Many maternal and fetal issues that present an increased risk tend to repeat in subsequent pregnancies.

The strongest predictor of poor fetal growth, or intrauterine growth restriction, is a history of a previous child of low birthweight and growth restriction.

Similarly, the strongest predictors of premature labor, hypertension, and gestational diabetes are previous pregnancies with these complications.

Some inherited conditions that can affect the baby can only be determined from careful review of the prenatal course, delivery, and neonatal course of previous pregnancies. It is for this reason that your obstetrician will go over each of your prior pregnancies, paying special attention to difficulties encountered during pregnancy, and the condition of the baby at birth.

For example, if a previous baby was thought to be premature due to its weight and expected due date, but had no difficulty with breathing, digestive function, or other evidence of premature organ function, it may be that the baby was not premature but small for gestational age. In such an ambiguous scenario, your obstetrician may want to order several ultrasounds for growth in the current pregnancy in order to detect any slowing of fetal growth.

Another example is a previous child who had what appeared to be bruising at birth, and was found to have a low platelet count. Platelet transfusion was done, and the child needed no further therapies. This may indicate that the mother has antibodies against platelets, the type of which the baby inherits from the father. It is vital to detect this from the history so that proper diagnosis and treatment can be done in the current pregnancy.

Your obstetrician will review with you the prenatal course, details of labor and delivery, and birth weight and neonatal course of the baby for each previous pregnancy. Of prime importance are things such as: did the baby have to go to the intensive care nursery? Did the baby go home when you did? Was there any issue for which you had to bring the baby back for tests or examinations before your six-week checkup? Did labor begin spontaneously, or was labor induced? If you had a c-section, what was the reason?

Of equal importance is the history of any issues that arose about your health during previous pregnancies. Did you gain excessive weight? Was your blood pressure elevated? Did you have to have more than one glucose challenge test? Was bed rest or work-related activity decrease recommended for any reason? Was there a suspicion of premature labor? If so, were you placed on any medications?

Just as a history of problems demands careful attention to recurrence of those problems, a completely negative history of a normal prenatal course, labor, delivery, and neonatal course is the strongest predictor of a normal outcome in the current pregnancy.