Human beings, in general, are meant to have one baby at a time. And just carrying that one can be challenging. If you are expecting two or even three babies at a time, the risks escalate for you and your babies.
Multiple pregnancy statistics
About 3% of births in the US are twins; of these, 70% are non-identical.
Triplets and higher order multiples are rarer – about 1 in a thousand. Let’s go over some of the ways that multiple pregnancies are different, then talk about managing these increased risks.
- Preterm birth – This is probably the complication that occurs most frequently with multiple gestations.
- Hypertension – Preeclampsia, and hypertension, in general, are more of a risk with multiples.
- Diabetes – Gestational diabetes is more likely because multiples are more of a metabolic stress.
- Growth restriction – Multiples are more likely to be smaller at birth.
- Birth defects – We don’t know why, but birth defects occur more frequently in multiples.
When risks increase
If twins share a placenta, there are additional risks.
First, let’s talk about Twin-twin transfusion or TTTS. This is a life-threatening condition that occurs in 10-15% of monochorionic twins (twins that share a placenta). I have a post about TTTS – check it out.
Another form of twin-twin transfusion is called Twin Anemia-Polycythemia Sequence or (TAPS) is where one twin has anemia and the other has an abnormally high blood count.
Managing risks well
So with all these increased risks, how do we manage twin pregnancies differently? I’m glad you asked.
First, we need to focus on ultrasounds. We like to see you in the first trimester with all pregnancies, but early ultrasound is especially important with multiples.
It is easier to determine how many babies and how many placentas and sacs when we scan early. This information is crucial because there are higher risks of complications when babies are in the same sac or share the same placenta.
You will need ultrasounds for growth since there is an increased risk of poor fetal growth with multiples. If the fetuses are monochorionic (sharing the same placenta), growth ultrasounds may be performed more frequently.
Doppler ultrasound may be performed to check for anemia and to look at flow through the umbilical cords, especially in monochorionic twins.
The chance of having gestational diabetes is higher, so we usually screen earlier. You may have a screening more than once during the pregnancy.
In the third trimester, we see you more frequently for fetal testing. This may involve non-stress testing, biophysical profiles, or some combination (see my posts on fetal testing for more information on types of testing).
What can you expect when you are carrying more than one baby? In general, more of everything.
More nausea in the first trimester, more weight gain, more heartburn, more swelling, and more pelvic pressure as the pregnancy progresses. So plan accordingly.
If you are able to rest in the middle of the day, do. Go to bed earlier, and give yourself more time to do daily activities. The most helpful habit that you can cultivate is a sense of humor. If you can make a joke and stay positive, you will be so much happier in the last month or two of this challenging pregnancy!
You have my best wishes.