High Risk Pregnancy and the Expanding Role of Occupational Therapy in Maternal Health

Sabina Khan PhD, OTD, OTR/L and Pamela Hess OTD, OTR/L

Abstract

High risk pregnancy affects approximately 15 to 20 percent of pregnancies in the United States and is associated with rising rates of severe maternal morbidity. While obstetric management prioritizes medical stabilization, the functional, cognitive, and psychosocial consequences of high-risk pregnancy are often underrecognized. Occupational therapy is uniquely positioned to address participation, health management, role continuity, and occupational balance during this medically complex period. This article highlights the functional implications of high-risk pregnancy and outlines practical applications for occupational therapy practitioners across Florida practice settings.

Why High-Risk Pregnancy Matters in Florida

Maternal health outcomes in the United States have become an urgent public health concern. More than 1,200 pregnancy related deaths occur annually, and severe maternal morbidity affects tens of thousands of women each year (Centers for Disease Control and Prevention [CDC], 2023). In Florida, hypertensive disorders represent a significant contributor to pregnancy-related mortality, with a pregnancy-related mortality ratio of 2.6 per 100,000 live births and markedly elevated risk among women aged 35 years and older, non-Hispanic Black women, and those with obesity (Florida Department of Health [FDOH], 2019).

High risk pregnancy includes medical, obstetric, or psychosocial conditions elevating adverse risks of maternal or fetal outcomes. Examples include hypertensive disorders of pregnancy, gestational diabetes, cardiac disease, autoimmune disorders, placenta previa, preterm labor risk, multiple gestation, and advanced maternal age (American College of Obstetricians and Gynecologists [ACOG], 2022). These diagnoses require close medical monitoring and behavioral management. However, risk classification does not fully capture lived experience.

High risk pregnancy often precipitates an abrupt reorganization of daily life. Established routines are reorganized around medical surveillance, activity restrictions, altered work participation, disrupted sleep, and shifting caregiving roles (Azevedo et al., 2025). Clinical appointments, fetal monitoring protocols, dietary modifications, medication regimens, and persistent uncertainty reshape the temporal and cognitive structure of the day (Khan et al., 2025). What was once self-directed becomes medically orchestrated.

 These changes extend well beyond physiological management, transforming how women engage in meaningful occupations, allocate energy, and sustain identity within valued roles. Participation becomes structured by risk mitigation rather than personal choice, constricting autonomy and narrowing occupational bandwidth. A high-risk pregnancy extends beyond a medical classification; it constitutes a complex occupational transition that alters routines, constrains agency, and disrupts role continuity (Khan et al., 2025). Because these shifts affect identity, participation, and functional balance, they require intentional, trauma-informed engagement within rehabilitation practice.

The Functional Impact Beyond Medical Risk

The literature consistently demonstrates high risk pregnancy is associated with increased anxiety, perceived loss of control, and role strain (Bayrampour et al., 2016; Jalal et al., 2024). Even when outcomes are favorable, the process of navigating medical complexity can reshape identity and daily functioning. Fatigue is one of the most reported symptoms across conditions such as preeclampsia and gestational diabetes (Effati-Daryani et al., 2021). Cognitive load increases as women track blood pressure readings, glucose levels, medication timing, symptom fluctuations, and appointment schedules. Tasks that were once automatic may require deliberate planning. Sleep fragmentation compounds executive strain.

Activity restriction, once commonly prescribed as bed rest, is now discouraged in many cases due to lack of evidence for improved outcomes and known risks including deconditioning and psychological distress (ACOG, 2020). Nevertheless, modified activity and precautionary guidance remain common,  such as a reducing work hours, limit lifting, avoid prolonged standing, or restrict travel. These changes can threaten financial stability and role identity.  Importantly, many women maintain functional capacity during this period; the central concern is not impairment, but the sustainability of participation over time. (Oztas & Tas, 2025). Therclinical task therefore is to determine how to safely support ongoing engagement in daily roles in ways that are adaptive and responsive to physiological vulnerability.

Occupational Therapy’s Unique Contribution

Occupational therapy offers a participation-centered framework that complements medical management by focusing on how individuals live within constraint, not simply how risk is reduced. In high-risk pregnancy, the concern is sustaining meaningful participation without cumulative physiological cost. Through detailed activity analysis, occupational therapists identify points where energy expenditure, cognitive load, and environmental demands exceed capacity (AOTA, 2020). Interventions such as pacing, ergonomic modification, environmental restructuring, and task reprioritization allow conservation without full withdrawal from valued roles.

Occupational therapy also translates complex health management demands into sustainable daily habits (AOTA, 2020). Monitoring routines, medication schedules, and symptom tracking are embedded into existing structures using cue-based systems and environmental supports. At the same time, practitioners address the psychosocial impact of restricted or surveilled pregnancy by supporting adaptive engagement in preparatory parenting, emotional regulation, and graded work participation (Penner & Rutherford, 2022). This integrated approach bridges physiology, participation, and identity during a medically vulnerable transition.

Expanding Occupational Therapy Presence in Maternal Care

As maternal morbidity continues to strain health systems nationwide, occupational therapy practitioners in Florida are uniquely positioned to expand their role within prenatal and maternal fetal medicine settings. High risk pregnancy is not solely an obstetric concern; it is a functional and occupational transition that reshapes daily routines, role expectations, and participation demands (Khan, 2025). By addressing sustainability, occupational balance, and adaptive engagement within the context of medical complexity, occupational therapy extends maternal care beyond physiological stabilization. This perspective advances not only safety and risk reduction, but the preservation of meaningful participation during one of the most vulnerable and transformative periods of adult life.   

References

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