Multiple Pregnancy: Twins or More

Always be sure to take extra good care of yourself when you are pregnant. When carrying twins or more (Reference multiple pregnancy Opens New Window), be sure to eat a Reference 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 also be different if you started your pregnancy underweight or overweight.

Prenatal care during a multiple pregnancy

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. These checkups are important both for monitoring your own health and your fetuses' health and for giving you and your health professional time to build a working relationship.

Because you are more likely to deliver early, be sure to plan ahead. Ask your health professional about making arrangements to deliver at a hospital that has facilities for emergency Reference cesarean delivery Opens New Window and a neonatal intensive care unit (NICU).

Watch for problems

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

• Reference Preeclampsia Opens New Window 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 Reference Preeclampsia and High Blood Pressure During Pregnancy.
• Problems with the placenta, such as Reference placenta abruptio Opens New Window or Reference placenta previa Opens New Window. For more information, see the topics Reference Placenta Abruptio and Reference Placenta Previa.
• Reference Anemia Opens New Window, 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 (Reference polyhydramnios). Treatment can include medicine and removal of amniotic fluid.
• Reference Urinary tract infection (UTI), which is treated with antibiotics.
• Heavy blood loss after delivery (postpartum Reference hemorrhage), which can require a blood transfusion.
• The need to deliver by Reference cesarean section (C-section). You will likely need a C-section if your babies (fetuses) are not turned head-down in time for birth (Reference breech or transverse fetus Opens New Window Reference Opens New Window).

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

Preterm labor is more common in a multiple pregnancy than in a pregnancy with one fetus. If you go into preterm labor and Reference 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, Reference tocolytic medicine Opens New Window is used in an attempt to delay preterm birth. You are closely watched if you are treated with a tocolytic medicine.

For more information, see the topic Reference Preterm Labor.

Possible problems for the babies (fetuses) during multiple pregnancy can include Reference vanishing twin syndrome Opens New Window, Reference twin-to-twin transfusion Opens New Window, twins that share one amniotic sac (monoamniotic twins), and Reference locking twins Opens New Window.

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 Reference multifetal pregnancy reduction (MFPR) near the end of your first Reference trimester Opens New Window. A successful MFPR increases the chances of healthy survival for the remaining fetuses and reduces risks to you. But MFPR sometimes leads to miscarriage.^{Reference 1}

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 adviser.

Opens New Window Multiple Pregnancy: Should I Have a Multifetal Pregnancy Reduction? Opens New Window

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