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Multiple Gestation: 6 Popular Questions Answered

Pregnant with twins or triplets? Be prepared. Cynthia DeTata - obstetrician at Stanford Health Care - answers the questions that will likely be bothering you while you’re expecting.

Are multiple gestations common today?  

Yes, it is becoming increasingly common. In the US, about 3% of live births are twin deliveries. The rate of naturally conceived twins varies with geography and ethnicity.  In Japan, the rate is 1.3/1000 live births, in the US 8/1000 and in Nigeria 50/1000.  

Older women are more likely to naturally conceive twins than younger women. With our increasing age of mothers, and infertility treatments, “iatrogenic” or medically induced twins have become much more common.  

What are the complications that are likely to develop with a multiple gestation?

Almost any complication of pregnancy is more common with multiples except macrosomia (large babies) or a postdates pregnancy (pregnancy continuing after the due date). 

Learn the day when you’re due with the accurate Due Date Calculator by Flo. 

First of all, having two babies and twice the placental mass can be a physical stress on the mother. She is more likely to have aches and pains, swelling, and fatigue. The increased iron requirements to support more than one fetus make it more likely the mother will have anemia

The placenta affects the metabolism of the mother, and with multiples there is more placental mass, making gestational diabetes more common.  

The physical work of circulating blood through the placentas increases the risk of gestational hypertension and preeclampsia, or toxemia of pregnancy. These problems might also occur earlier in pregnancy than they might with a single fetus.

The increased weight of the pregnancy and stretch of the uterus increases the risk of preterm labor, preterm premature rupture of membranes, and of preterm delivery.   Over half of all twins are born prematurely (before 37 weeks), this risk is increased with triplets and quadruplets.  Premature babies have more problems with eating, breathing, fighting infections and are at increased risk of long term problems such as developmental delay, blindness or seizures. 

Mothers with twins should seek care with a doctor who is experienced and knowledgeable about twin pregnancy. They should plan for additional appointments and monitoring, and may need to stop work early in order to have the best chance of a healthy pregnancy.


What are the risks to the fetus in a multiple pregnancy?

In multiple gestations, the babies compete for nutrition from the mother, and one baby may grow more than the other. If one baby is not going well, your doctor might recommend an early delivery for the sake of that twin. Unfortunately, it is not possible to deliver only one of the twins and leave the other one inside the mother.  

Placental problems are more common in multiple gestations, such as placenta previa, placental abruption and twin-twin transfusion.  


Spontaneous twins have an increased risk of having genetic problems and birth defects.  

Labor is also more risky with an increased risk of operative delivery as well as an increase in postpartum hemorrhage.  

Will a multiple pregnancy affect the management of labor and delivery?

Yes, mothers with twins are more likely to need a cesarean delivery for many reasons. However, you might be able to attempt a vaginal delivery in two situations:


  1. Both babies are head down, or vertex
  2. The first baby is head down, and the second baby is in any position but smaller than the first baby.

How much should I gain during pregnancy? 

Mothers with twins should gain more weight than mothers with single babies. The recommendation varies with the BMI of the mother:

Mother’s BMI Weight gain
< 24.9 (normal or underweight) 37-54 pounds, or 18.8-24.5 kg
25-29.9 (overweight) 31-51 pounds, or 14.1-22.7 kg
> 30 (obese)   25-42 pounds, or 11.1-19.1 kg

What about breastfeeding?

Breastfeeding can be a challenge for mothers of multiples, particularly if the babies have problems with their health or growth, or are born prematurely. However, many women are able to breastfeed twins and triplets without additional supplementation. 

At first, the mother might need to feed one baby at a time, particularly if she delivered by cesarean and cannot move around easily.  

Later as mother and babies learn to breastfeed together, it is possible to feed two babies at once. Breastfeeding benefits all babies, and the mother as well. 

Since babies from multiple gestations are more likely to be born early, the benefits of breastfeeding are even more important to help them be as healthy as possible.

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