Twin and Multiple Pregnancies

For some expectant mothers, their happiness is multiplied when they are expecting twins, triplets or more. To make this journey more joyful, it is good to understand your body’s needs and what you can expect during your pregnancy and beyond.

Symptoms of Multiple Pregnancy

Women pregnant with multiples will have the same symptoms as women expecting a single baby, including morning sickness, nausea and food cravings, but these symptoms may be more pronounced.

Extra Weight Gain – Mothers of twins or triplets may gain more weight than those with a single pregnancy. During the first trimester this gain is due to the increased blood volume and size of the uterus. Usually the weight gain for multiple pregnancies is 15-25 pounds, while for mothers carrying a single baby it is around 10-20 pounds.

Rapid weight gain during the first trimester is a possible indicator of a multiple pregnancy.

Big for Gestational Age – Increased uterine size or starting to show early, is another indicator of multiple babies. During your prenatal checkups, you may hear that you seem large for the gestational age. As the weeks pass, your uterus will continue to be big for the gestational age.

High AFP Levels – Alpha-fetoprotein is a protein released by the baby as it grows, found in the mother’s blood. If the level is higher than expected, you may be pregnant with multiple babies.

The AFP test is usually done at 16-18 weeks. A high level may also indicate a problem with the baby, therefore an ultrasound after the test is the best way to find out if you are carrying more than one baby.

Severe Morning Sickness – The early signs of pregnancy, such as nausea, vomiting, breast tenderness and hunger may be exaggerated, though this is not always the case and varies from one individual to the next.

Extreme Fatigue – Mothers carrying twins, triplets or quadruplets may tend to get tired easily and feel that they lack energy. This is because of the extra physical strain that the body is experiencing, and is one of the most common multiple pregnancy symptoms, though you may not realise it.

Multiple Foetal Heartbeats – With the help of a Doppler machine it is possible to hear the foetal heartbeat after about 12 weeks. If your health care provider can distinctly hear two or more, you are carrying multiples.

Ultrasound – An ultrasound image may show multiple embryo sacs, multiple embryos and multiple heartbeats if you are carrying multiples. These can be detected as early as six weeks into the pregnancy.

Prenatal Care

Eating well, sleeping well, gaining weight and regular doctor visits are things that every expectant mother must do, but if you’re having multiple babies you might need to be extra diligent to make sure that you receive adequate prenatal care.

Nutrition – Generally, all pregnant women are asked to increase their dietary intake of folic acid, calcium and iron. Mothers of multiples need around 1600 to 2000 mg of calcium each day, which can be obtained from foods such as milk, orange juice and broccoli. Increasing your intake of dairy products is also recommended.

Similarly, the amount of folic acid you will need is higher and regular doses during the first trimester is important to help ensure that your babies will not suffer from any neural tubal defects.

Iron is required for haemoglobin production. During multiple pregnancies, mothers are at greater risk of becoming anaemic, so doctors recommend a higher dose of iron and may prescribe an iron supplement. Insufficient intake of iron may lead to fatigue, anaemia and a lower oxygen supply to the babies.

All other nutrients, such as proteins, zinc, copper and vitamins are also required in a slightly higher quantity and you may need to take supplements. Be careful with your dosage; too much of these nutrients can be just as harmful as too little.

Gaining Weight – How much weight you gain depends on the number of foetuses you are carrying. Women carrying twins are advised to gain around 30-45 pounds in total throughout pregnancy, those carrying triplets should usually gain around 50-60 pounds. Most of the weight gain should occur during the first 20-25 weeks of pregnancy, as this will help to reduce the risk of preterm labour and low birth weight.

In general, doctors suggest that in addition to a normal, healthy diet, you take in an additional 300 calories of food for every baby you are carrying.

Special Care – As a mother of twins or more, you may have to visit your doctor more often than for a singleton pregnancy. This is suggested since the chances of complications are slightly higher with a multiple pregnancy and the doctor may need to monitor your and your babys’ health status closely. Twice monthly visits during the second trimester and weekly visits during the third, are the norm.

As there is an elevated risk of preterm labour, women expecting multiples may have to go through a vaginal ultrasound examination, or internal exam, to see if the cervix is shortening at around 20 weeks. If a risk is identified, bed rest or drugs to postpone labour may be prescribed. In some cases, drugs, such as corticosteroids, can be used to speed up lung development so that pre-term babies will experience fewer breathing problems.

Even without the risk of preterm labour, women carrying multiples are asked to reduce their activities as much as possible and take more bed rest during the third trimester.

Childbirth

Although the risk of preterm labour is higher, it does not always occur in multiple pregnancies. It is also possible to avoid a caesarean and have a vaginal birth if your pregnancy has been problem free.

In multiple pregnancies, childbirth usually takes place about 2 weeks earlier than in single pregnancies. Because of this, it is a good idea to be prepared for labour well in advance of your due date.

During your labour, you may be connected to a foetal monitor, which will continuously check the condition of each baby. Normally, there is a gap of less than one hour for each baby during a vaginal delivery and because the babies are generally smaller in size, you may feel that it is easier to push them out.

Sometimes during multiple births the placenta or umbilical chord may compress, requiring an emergency c-section even if one baby has already been delivered vaginally. With twins, there is a good chance that one child in will be in a headfirst position and the other in breech. The delivery of triplets, or more babies, is generally done by c- section.

If the babies are born preterm, the health of both you and your babies will need to be monitored for a time. If lungs had not yet fully developed, babies may be kept on ventilators, or in incubators, until the have sufficiently developed.

Risks

Some of the complications associated with multiple pregnancy and births are:

• Higher risk of anaemia in the mother
• Elevated risk of < href=”/hyperten.asp”>pre-eclampsia, or pregnancy induced high blood pressure.
• Higher risk of developing gestational diabetes
• Higher risk of preterm labour and complications associated with it
• Bleeding before birth
• Miscarriage of one or more foetus very early, or very late in the pregnancy
• Genetic defects
• Intrauterine growth restriction i.e. babies growing at a different rate.