Multiple Pregnancy: Twins or More

Treatment Overview

It is always important to take extra good care of yourself when pregnant. When carrying twins or more (multiple pregnancy), be sure to eat a balanced and nutritious diet of quality calories, and make sure that you get enough calcium, iron, and folic acid.

You can expect to gain weight more quickly than you would with one fetus. With each additional fetus a woman carries, her range of weight gain will increase.

Your range of healthy weight gain will be different if you started your pregnancy underweight or overweight.

High-risk pregnancy care

If you are pregnant with twins or more, good prenatal care will help you and your health professional prevent and watch for problems. You will have more frequent checkups than you would for a pregnancy with one fetus.

Complications can develop at any time during and after a multiple pregnancy. These include medical complications that:

• Affect the mother and fetuses, such as miscarriage, preterm labor and/or preterm birth, preeclampsia, gestational diabetes, and serious placenta problems.
• Affect the fetuses before birth, such as vanishing twin syndrome, twin-to-twin transfusion, and a higher risk of disability and genetic disorders.
• Affect the newborns because of premature birth, such as lung, brain, heart, and eye problems.
• Result in long-term disability for the babies. These can include mental retardation, cerebral palsy, learning disabilities, blindness, or deafness. These are most likely among babies born before 28 weeks.

Because you are more likely to deliver early, be sure to plan ahead. Ask your health professional about making arrangements to deliver at a specially equipped hospital. Such a hospital has facilities for emergency cesarean delivery, as well as a neonatal intensive care unit (NICU).

Early pregnancy decisions about triplets or more

When there are three or more fetuses in the uterus, their risks of disability or death are higher with each additional fetus. If you are carrying triplets or more after infertility treatment, your doctor may offer the option of multifetal pregnancy reduction (MFPR) near the end of your first trimester. A successful MFPR increases the chances of healthy survival for the remaining fetuses and reduces risks to you. But MFPR sometimes leads to miscarriage.⁶

The decision to have a multifetal pregnancy reduction is difficult and traumatic. If you are faced with this decision, talk to your doctor about your personal risks from trying to carry multiple fetuses to term compared to the risks of choosing MFPR. Also consider discussing your decision with a counselor or spiritual advisor.

Should I have a multifetal pregnancy reduction?

Preterm labor is more common in a multiple pregnancy than in a pregnancy with one fetus. If you go into preterm labor and premature delivery is likely, your health professional may recommend taking one or more precautions, such as:

• Limiting your activity level.
• Staying in the hospital. This is often so that you can receive steroid medicine to help your babies' lungs develop faster. In some cases, tocolytic medicine is used in an attempt to delay preterm birth. You are closely watched if you are treated with a tocolytic medicine. Complications of some tocolytics, such as pulmonary edema, are more common when you are carrying twins or more.¹

There is no evidence that bed rest and home labor monitoring can prevent premature labor.⁶ But they still are sometimes done. Talk to your doctor about whether partial bed rest and reduced activity might work well for you. See the topic Preterm Labor for more information.

Possible pregnancy problems that can be more likely when carrying twins or more include:

• Preeclampsia and high blood pressure. Treatment depends on how severe your condition becomes. It may include medicine, bed rest, fetal monitoring, and early delivery. For more information, see the topic Preeclampsia and High Blood Pressure During Pregnancy.
• Problems with the placenta, such as placenta abruptio or placenta previa. For more information, see the topics Placenta Abruptio and Placenta Previa.
• Anemia, which is treated with iron-rich foods and iron supplements. If this doesn't help, you can be tested for other problems that can cause anemia.
• Too much amniotic fluid in the uterus (polyhydramnios). Treatment can include medicine and removal of amniotic fluid.
• Urinary tract infection (UTI), which is treated with antibiotics.
• Heavy blood loss after delivery (postpartum hemorrhage), which can require a blood transfusion.
• The need to deliver by cesarean section (C-section). This is usually the case when fetuses are not turned head-down in time for birth (breech or transverse fetus).

Any pregnancy can have these complications, but there is more concern about them happening during a multiple pregnancy.

Fetal complications

Possible complications that can affect multiple fetuses during pregnancy include labor complications, the healthy growth of one twin and poor growth of the other twin, and birth defects.

Infant complications

Giving birth early, called premature birth, is common in multiple pregnancies. Premature newborns usually need care in a neonatal intensive care unit (NICU) until they are mature and well enough to go home.

When born too early, a premature infant's major organs are not fully developed. This can cause health problems. Although any premature infant has some increased risk of medical complications, those who are born before 32 weeks of pregnancy have a higher risk. This risk increases with each additional week of prematurity.

Long-term disability resulting from premature birth requires specialized care over time. For more information, see the topic Premature Infant.

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Author:	Debby Golonka, MPH	Last Updated: July 24, 2007
Medical Review:	Adam Husney, MD - Family Medicine Gregory A L Davies, MD, FRCSC, FACOG - Maternal-Fetal Medicine
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