Finding out you're carrying twins can come with double the joy and excitement. It may also mean you have more questions about your health and the health of your little ones.
It's true that extra babies come with some extra risks, and pregnancies with multiples are classified as high-risk. But most moms expecting twins and other multiples have relatively uneventful pregnancies — at least in terms of complications.
Also, while risks and complications are hard to avoid when you're carrying multiples, you may be able to manage or even prevent many of them. Here's what you need to know.
Potential complications for babies during a twin pregnancy
Early labor and low birth weight
Twins, on average, come out sooner — and smaller — than singletons. Your womb may be a cozy place, but it can get crowded in a hurry as they grow. That's why full-term for twins is considered 38 weeks, not the typical 40 weeks.
Preterm birth — delivery before 37 weeks of pregnancy — is the most common complication when you're pregnant with multiples. About 50 percent of twins are born early. Twin delivery, on average, occurs around 35 to 36 weeks. Triplets and quadruplets may come even sooner. Moms of singletons, on average, deliver at 39 weeks.
Since many twin births happen early, the average twin arrives weighing about 5 1/2 pounds. This is considered low birth weight, but most 5-pounders end up doing just fine, thanks to medical advances in caring for small newborns. All preterm babies are at increased risk for health complications during infancy and long-term issues like learning disabilities and even cerebral palsy. The risk goes up the more preterm they are and the smaller they are at birth.
To reduce your babies' risk, know the signs of preterm labor and call your doctor if you experience any of them. Twins are typically monitored more closely than single babies for those signs using measures like cervical lengths.
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Signs of early delivery can include the following, though most moms who experience these symptoms don't give birth early. But it's worth checking in with your practitioner nonetheless.
- Persistent cramping (like period cramps that can but don't always include diarrhea, nausea or indigestion)
- Painful contractions 10 or fewer minutes apart that don't subside when you change positions
- Pain that comes and goes in the center of the back or wrapping in a band around the lower back
- Vaginal discharge that's watery, pink-streaked or brownish with blood
Adequate nutrition and weight gain can actually help lower your risk of preterm labor. So you'll want to make sure you're taking care of your health and following a good pregnancy diet that includes the extra calories (about 600 per day for twins) you may need to help maintain your babies' growth in utero.
Twin-to-twin transfusion syndrome
This is an in-utero condition where twins get an uneven amount of blood. One fetus gets too much blood, while the other gets too little. It's a rare complication that happens in about 5 to 15 percent of pregnancies where identical twins share the same placenta, called monochorionic twins. Though this condition is not dangerous for the mom, it can be dangerous for the babies.
Your practitioner might refer you to a perinatologist, a doctor who specializes in pregnancy complications, for closer monitoring and possible treatment should problems arise if you have monochorionic twins, since the chance of twin-to-twin transfusion syndrome is higher with them.
The perinatologist may perform laser therapy on the placenta to stop the flow of blood from one twin to the other. Your doctor may also opt to drain excess amniotic fluid with amniocentesis every week or two to reduce the risk of preterm labor with this complication.
Potential complications for moms during a twin pregnancy
Preeclampsia
Preeclampsia is a pregnancy complication where an expectant mom develops high blood pressure. Any pregnant woman can have preeclampsia, but it's more common among moms expecting multiples. The additional placenta — and the extra hormones that come with two babies — can lead to high blood pressure and preeclampsia.
The condition affects 15 to 20 percent of moms of twins. If it's not treated, preeclampsia can be dangerous for Mom — triggering seizures and premature delivery. But thanks to careful monitoring, it's usually caught early.
To reduce your risk, it's important to start prenatal care early and continue it throughout your pregnancy. Your practitioner will monitor your blood pressure carefully. If you do develop preeclampsia, the treatment is usually to deliver your babies unless they're very premature, in which case other treatment options will need to be explored while the babies mature a bit more.
Call your doctor right away if you experience any of the following symptoms, as they may be signs of preeclampsia:
- Swelling of the hands and face or area around your eyes
- Sudden weight gain over one to two days
- Vision issues or headaches
Gestational diabetes
Moms expecting multiples are more likely to have high blood sugar levels during pregnancy and therefore are more likely to be diagnosed with gestational diabetes, which is diabetes that only appears during pregnancy.
Pregnancy hormones and other changes like weight gain cause insulin resistance, meaning your body uses insulin less effectively. Insulin is the hormone that helps your cells turn food into energy by absorbing sugars from the bloodstream. Insulin resistance, in turn, causes gestational diabetes.
Gestational diabetes can increase your babies' birth weight and raise the risk of delivery complications if it's not detected. Luckily, diet can usually control or even prevent gestational diabetes, though some women may need extra insulin.
Be sure to get a glucose screening test at the appropriate time during your pregnancy, exercise regularly and stick to a healthy pregnancy diet that's low in simple carbs and high in protein and fiber.
Placental problems
Women carrying multiples are at a higher risk of placenta previa (low-lying placenta) and placental abruption (premature separation of the placenta from the wall of the uterus).
Regular prenatal checkups and careful monitoring during pregnancy will help ensure that your practitioner can detect any placental problems and take the steps necessary to manage them.
Complications of carrying twins conceived via IVF
Undergoing IVF can increase your chances of having twins or multiples, partly because women who have IVF sometimes transfer two or more embryos to hedge their bets that one will survive to full-term (multiples result when all the embryos survive) and partly because embryos are more likely to split into two with IVF.
If you are carrying twins conceived via IVF, the possible risks and complications are generally the same as they would be for women who conceived twins naturally.
Postpartum depression
Some research studies have suggested that women who conceive using assisted reproductive technologies such as IVF are at a greater risk of developing postpartum depression than women who conceive naturally.
Other studies show that moms of multiples are more likely to get postpartum depression. Since women who conceive with IVF often have multiple births, it's not clear which factor might be responsible for the association.
Speak up if you're feeling any symptoms of postpartum depression, such as intense sadness or anxiety after giving birth. While some of that is normal, excessive emotion that interferes with your daily functioning warrants a call to your practitioner, who can help you get the treatment you need before it interferes with recovery and the early days of parenting.
Potential complications during delivery of twins
When you have two babies to deliver, birth can get a little more complicated. Twin births have more variables — and surprises — than single births. You may have a planned vaginal birth, a planned C-section, an unplanned C-section, or a mixed birth where one twin is delivered vaginally and the other via C-section.
Here are some potential complications that can happen during the birth of your twins:
Unplanned C-section
Many moms who are expecting twins have successful vaginal births. If you are preparing for a vaginal delivery with twins, it's important to understand that there's a greater likelihood your pregnancy may require an unplanned C-section.
The delivery procedure will depend on the positioning, health and weight of each baby and how labor is progressing. Certain conditions, such as preeclampsia, may also up your chances of an early, unplanned C-section.
Mixed delivery
In very rare cases, it might be necessary to deliver your second baby by C-section after the first baby has been delivered vaginally. This is usually only done in an emergency situation such as a placental abruption or a cord prolapse (where the umbilical cord drops into the vagina ahead of the baby).
A mixed delivery can be scary, and it means postpartum recovery from both vaginal and surgical delivery. But when it's necessary, it can save the lives of your little ones, which is well worth the added recovery time.
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