Multiple Pregnancy Complications

Common pregnancy complications:

If you’re pregnant with multiples, you may be at increased risk for these complications:

• Gestational diabetes is more common when expecting multiples because of the larger placenta size that produces more pregnancy hormones. All pregnant people are screened for gestational diabetes in the third trimester, typically between 24 and 28 weeks. If you’re diagnosed with gestational diabetes, medical therapy may be required to control your blood sugars. This condition is temporary, resolving after pregnancy.
• Hypertensive disorders, such as high blood pressure and preeclampsia, may develop in the second half of pregnancy. If you’re diagnosed with hypertension or preeclampsia, you may need increased monitoring, medication, hospitalization and/or early delivery.
• Anemia occurs when the count of healthy red blood cells is low. Pregnant people carrying multiples have a higher risk of developing anemia due to greater nutritional demands. Many cases are mild and can be easily treated with iron supplements.
• Gastroesophageal reflux disease (GERD), commonly known as heartburn, often affects people carrying multiples. Small lifestyle and diet changes can typically lessen the severity of symptoms.
• Sciatica and low-back pain are more common during a multiple pregnancy, but not considered dangerous. Your provider can offer suggestions to ease any discomfort.

Common complications in babies

Your babies may be at increased risk of:

• Preterm birth is birth that occurs before 37 weeks. It’s the most common complication for a multiple pregnancy. Pregnant people carrying twins on average deliver around 36 weeks. Those carrying triplets deliver around 32 weeks. Pregnant people carrying quadruplets deliver around 28 weeks. Babies born prematurely will typically spend time in the Neonatal Intensive Care Unit (NICU).
• Intrauterine growth restriction (IUGR) is a condition in which an unborn baby is estimated to weigh less than expected for their gestational age. Multiples are at higher risk of IUGR because of placental crowding. One or all of the babies being smaller than expected is common in a multiple pregnancy. In most cases, IGUR is mild and does not lead to any complications. In some cases, it is more serious and leads to a preterm delivery with complications for the newborns.
• Twin-to-twin transfusion syndrome (TTTS) can occur with monochorionic diamniotic (Mo-Di) twins. The babies share one placenta and connections of blood vessels, which can become unbalanced and lead to one twin having more volume than the other. TTTS is diagnosed using ultrasound that measures the twins' amniotic fluid volume.
• Selective growth restriction is diagnosed when monochorionic twins differ in size by more than 20 percent and one of the twins is growth-restricted. Monochorionic twins with this condition are at higher risk of fetal distress and thus preterm delivery.
• Twin anemia polycythemia sequence (TAPS) is a rare condition that affects 3 to5 percent of monochorionic twins and about 10 percent of monochorionic twins that have undergone a fetoscopic laser procedure for treatment of TTTS. It occurs from the unbalance in vascular connections between twins.
• Cord entanglement can occur with monochorionic monoamniotic (Mo-Mo) twins. Since Mo-Mo twins share an amniotic sac, it is common for their umbilical cords to become entangled during the pregnancy. This increases the risk that the cords will become compressed and that blood flow to one or both twins will be interrupted.

Why Choose Us When Expecting Multiples

• In the Center for Multiples, our team has extensive experience in every aspect of multiple pregnancy, delivery and newborn care. More than 200 mothers deliver twins, triplets or quadruplets here each year.
• Our team offers deep experience in all potential complications of a multiple pregnancy for both mother and babies, including growth restriction due to uterine crowding and uteroplacental insufficiency; shared placenta; and the rare twin-to-twin transfusion syndrome.
• Our skilled and compassionate team of physicians, nurses and support staff – including social work, nutrition, genetic counseling, lactation and more – are available to guide and educate you and your family at every step along this journey.
• The NICU advantage: Our Level III Neonatal Intensive Care Unit (NICU) – the most state-of-the art in New England – provides reassurance that even babies born early will have the best start possible. Our twin and triplet rooms and lactation support services for feeding twins or more babies are just two of the reasons why Brigham and Women’s is a destination for families expecting multiples.
• Our childbirth education series features opportunities for families expecting multiples to receive information tailored to the unique aspects of expecting, delivering and caring for twins, triplets and high-order multiples.
• Our team of experts offers Virtual Visits to connect with you and your family while you stay at home. Many appointments, including an initial consult, second opinion, monitoring, or follow-up care, can effectively be held virtually so you can begin or continue your multiple pregnancy care.

Our experts in the Center for Multiples are available to connect with you in person and with Virtual Visits. To request an appointment, call 617-732-5130 or submit the form below.