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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.

A woman and her twin babies

Is multiple gestation 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 multiple gestation?

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

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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 make it more likely the mother will have anemia

A mother’s metabolism is affected by the placenta, 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.   

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.   

Mothers with twin pregnancies are at increased risk of complications with other organ systems such as the liver with IHCP (Intrahepatic cholestasis of pregnancy) and the skin with PUPPP (pruritic urticarial papules and plaques of pregnancy).

What are the risks to the fetus growth and development?

The babies compete for nutrition from the mother, and one may grow more than the other. Placental problems are more common.  

There is a particular problem of pregnancy seen in one kind of twinning that is known as twin-twin transfusion.   

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Spontaneous twins have increased genetic risks. Labor is also more risky with an increased risk of operative delivery as well as an increase in postpartum hemorrhage.  

Will multiple pregnancy affect the management of labor and delivery?

Yes, there is an increased risk of cesarean delivery for many reasons. However, you can 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? 

A woman pregnant with twins measures her weight

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.

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