FAQs About Pregnancy with Twins, Triplets and More

A multiple pregnancy typically brings the same symptoms and discomforts as a single pregnancy – but to a greater degree.

Some women experience more nausea when more than one baby is developing due to higher levels of pregnancy-related hormones, and a small percentage may even require intravenous fluids. Discomforts of back pain, acid reflux and sleeping difficulties also are more pronounced with multiples. Medical conditions that occur more frequently with multiple pregnancy include gestational diabetes and hypertension disorders (including preeclampsia).

Women expecting multiples also may experience more depression and anxiety due to the stress and uncertainty of welcoming more than one baby.

Approximately 60 percent of twins and nearly all triplets are born prematurely (defined as prior to 37 weeks). The more babies you carry, the greater the likelihood for an early birth. Women carrying twins usually deliver their babies around 36 weeks gestational age (instead of 39 or 40 weeks for a single pregnancy). Triplet birth is generally around 32 weeks.

A premature baby’s body systems and organs may not be fully matured, leaving the newborn more vulnerable to complications. Due to the risk of prematurity, many families expecting multiples plan for the birth to be in a hospital where a high-level Neonatal Intensive Care Unit (NICU) is available to support even the smallest babies.

At Brigham and Women’s Hospital, most babies born at less than 35 weeks gestation are cared for in our Level III NICU, where we care for babies as young as 23 weeks gestation. Time and expertise in the NICU ensure that the babies are as healthy as possible, and parents are prepared, when they go home.

For any pregnancy, first-time moms tend to start showing between 12 and 16 weeks; experienced moms show earlier. With multiples, you are likely to show sooner, as the growing babies (and placentas and amniotic fluids) cause the uterus to expand.

The only way to confirm a multiple pregnancy, and your expected due date, is through ultrasound imaging requested by a physician.

The biggest risk of multiple pregnancy is premature birth — and the more babies you carry, the greater the likelihood of an early birth. This can be due to medical conditions that occur more frequently with multiples, including hypertension, gestational diabetes and placental disorders.

Women expecting twins or more also face the challenge of achieving adequate nutrition to support more than one baby. In the Center for Multiples at Brigham and Women’s Hospital, nutritionists work with you to provide recommendations and tips for consuming the calories and high-value nutrients you need to keep yourself and your growing babies healthy.

Maternal-fetal medicine practices that include a multi-specialty team of nurses, nutritionists, social workers and specialist physicians can provide the most complete care for the full range of needs in a multiple pregnancy and birth. All of these specialists and more are available to you and your family at the Center for Multiples.

Most twin pregnancies result in a healthy outcome for mothers and babies. But multiples do come with added risks. This includes a greater risk of miscarriage (which increases with the number of fetuses), birth defects, growth restriction and the rare twin-to-twin transfusion syndrome.

For mothers, multiple pregnancy increases the risks of gestational diabetes, anemia, hypertension/preeclampsia and early birth (often because of these conditions).

IVF technology, which increases the likelihood of multiples, also is associated with some risks, such as placenta abnormalities that can complicate delivery.

To monitor for these risks, maternal-fetal medicine physicians generally schedule more frequent check-ups and additional prenatal tests. For delivery, these obstetricians usually are associated with medical centers that are prepared for complications and work with a multi-disciplinary team that has experience in multiple births.

It is recommended that all pregnant women drink 8 to 10 large glasses of water daily, totaling 64 to 80 ounces. Women expecting multiples should drink at least this amount because of the extra demands placed on your system by the needs of multiple growing babies. Staying hydrated also helps to prevent urinary tract infections, constipation and hemorrhoids, and may keep you comfortably cool and minimize swelling as the water flushes sodium from your system.

Women facing multiple pregnancy will appreciate the helpful tips offered by the nurses at high-risk obstetrics (also called maternal-fetal medicine) practices. This is especially true in a practice that see a high volume of multiples pregnancies, as we do at the Center for Multiples at Brigham and Women’s Hospital, where we are accustomed to answering every question you might have.

At Brigham and Women’s Hospital, where 200 or so women give birth to multiples each year, delivery of multiple babies occurs in an operating room. This is in case a Cesarean section is needed – but with our experienced team, surgical birth is not always needed for twins. The mode of delivery will depend on the babies’ position, estimated weight, gestational age and any risks specific to that mother. Our experienced maternal-fetal medicine specialists are skilled in vaginal delivery for twin births when it is a safe option. For triplets and high-order multiples, Cesarean delivery is almost always the case.

An operating room also allows more space to accommodate multiple babies and the many care teams involved. At Brigham and Women’s Hospital, each multiple birth is attended by:

• nurses who care for the mother
• a maternal-fetal medicine specialist
• for each baby, a team that includes at least one physician expert in newborn medicine and one neonatal nurse
• often a respiratory therapist to be prepared for any breathing assistance a newborn might need

One support person also may attend the family-centered birth experience in which you see, touch and hold your babies as soon as safely possible.

Nearly every complication that might occur in a single pregnancy is more common with multiples. Many of these conditions lead to premature birth, which is the most common complication with all multiples. Premature babies may need help breathing, eating, fighting infections and regulating their own body temperature – care that is best provided in a Neonatal Intensive Care Unit (NICU). Growth restriction (slowed growth after 30 weeks) also is far more likely in multiple pregnancy and may require an early birth.

A few complications are specific to multiple pregnancies, including a placenta shared between two babies (which occasionally leads to rare and serious twin-to-twin transfusion syndrome). Such conditions require close monitoring by a maternal-fetal medicine specialist, who ideally works in collaboration with experts in newborn medicine.

The Center for Multiples at Brigham and Women’s Hospital offers expertise in all potential complications of multiple pregnancy and birth. Our team coordinates prenatal visits and ultrasounds and provides expert monitoring and support for all possible risks.