What is Multiple Pregnancy

Having a multiple pregnancy means that a woman is carrying more than one baby at a time. She may be pregnant with twins, triplets, or more. The majority of multiple pregnancies are twins. Naturally conceiving triplets or more (higher-order multiples) is rare.

Multiple pregnancies are riskier than single pregnancies. A woman with a multiple pregnancy is more likely to have certain problems during her pregnancy. Therefore, she will need to have more frequent appointments for prenatal care.

How does a multiple pregnancy happen?

A multiple pregnancy happens when:

• The woman’s body releases more than one egg at a time, and then each egg gets fertilized by a different sperm.
  • This is the most common type of multiple pregnancy.
  • Twins or other multiples produced this way are fraternal. They are no more alike than non-multiple siblings are.
• One sperm fertilizes one egg, which then divides into more than one embryo.
  • Twins or other multiples produced this way are identical. Identical multiples are always the same gender, and they look very much alike.

Who is most likely to have a multiple pregnancy?

A multiple pregnancy is more likely to develop in women who:

• Have had fertility treatment, especially if the treatment included fertility drugs.
• Are older than 35 years of age.
• Have already had four or more children.
• Have a family history of multiple pregnancy.

How is a multiple pregnancy diagnosed?

A multiple pregnancy may be diagnosed based on:

• Symptoms such as:
  • Rapid weight gain in the first 3 months of pregnancy (first trimester).
  • More severe nausea and breast tenderness than what is typical of a single pregnancy.
  • The uterus measuring larger than what is normal for the stage of the pregnancy.
• Blood tests that detect a higher-than-normal level of human chorionic gonadotropin (hCG). This is a hormone that your body produces in early pregnancy.
• Ultrasound exam. This is used to confirm that you are carrying multiples.

What risks are associated with multiple pregnancy?

A multiple pregnancy puts you at a higher risk for certain problems during or after your pregnancy, including:

• Having your babies delivered before you have reached a full-term pregnancy (preterm birth). A full-term pregnancy lasts for at least 37 weeks. Babies born before 37 weeks may have a higher risk of a variety of health problems, such as breathing problems, feeding difficulties, cerebral palsy, and learning disabilities.
• Diabetes.
• Preeclampsia. This is a serious condition that causes high blood pressure along with other symptoms, such as swelling and headaches, during pregnancy.
• Excessive blood loss after childbirth (postpartum hemorrhage).
• Postpartum depression.
• Low birth weight of the babies.

How will having a multiple pregnancy affect my care?

Your health care provider will want to monitor you more closely during your pregnancy to make sure that your babies are growing normally and that you are healthy.

Follow these instructions at home:

Because your pregnancy is considered to be high risk, you will need to work closely with your health care team. You may also need to make some lifestyle changes. These may include the following:

Eating and drinking

• Increase your nutrition.
  • Follow your health care provider’s recommendations for weight gain. You may need to gain a little extra weight when you are pregnant with multiples.
  • Eat healthy snacks often throughout the day. This can add calories and reduce nausea.
• Drink enough fluid to keep your urine pale yellow.
• Take prenatal vitamins.

Activity

By 20–24 weeks, you may need to limit your activities.

• Avoid activities and work that take a lot of effort (are strenuous).
• Ask your health care provider when you should stop having sexual intercourse.
• Rest often.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Do not drink alcohol or use illegal drugs.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Arrange for extra help around the house.
• Keep all follow-up visits and all prenatal visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have dizziness.
• You have persistent nausea, vomiting, or diarrhea.
• You are having trouble gaining weight.
• You have feelings of depression or other emotions that are interfering with your normal activities.

Get help right away if:

• You have a fever.
• You have pain with urination.
• You have fluid leaking from your vagina.
• You have a bad-smelling vaginal discharge.
• You notice increased swelling in your face, hands, legs, or ankles.
• You have spotting or bleeding from your vagina.
• You have pelvic cramps, pelvic pressure, or nagging pain in your abdomen or lower back.
• You are having regular contractions.
• You develop a severe headache, with or without visual changes.
• You have shortness of breath or chest pain.
• You notice less fetal movement, or no fetal movement.

Summary

• Having a multiple pregnancy means that a woman is carrying more than one baby at a time.
• A multiple pregnancy puts you at a higher risk for certain problems during and after your pregnancy, such as: having your babies delivered before you have reached a full-term pregnancy (preterm birth), diabetes, preeclampsia, excessive blood loss after childbirth (postpartum hemorrhage), postpartum depression, or low birth weight of the babies.
• Your health care provider will want to monitor you more closely during your pregnancy to make sure that your babies are growing normally and that you are healthy.
• You may need to make some lifestyle changes during pregnancy, including: increasing your nutrition, limiting your activities after 20-24 weeks of pregnancy, and arranging for extra help around the house.