Table of ContentsView AllTable of ContentsConceptionSymptomsRisks and Complications
Table of ContentsView All
View All
Table of Contents
Conception
Symptoms
Risks and Complications
Pregnancy is often an exciting and gratifying experience, but when you are expecting twins, there is more to consider. Read on to learn what to expect and possible complications you may experience if you’re pregnant with twins.
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Conception happens when the sperm fertilizes an egg within days of ovulation.
Menstrual cycles average 28 days and ovulation typically happens mid-cycle—around day 14. A woman’s ovary normally releases one egg during ovulation. There are two ways twin pregnancies can occur:
Identical twins are rarer than fraternal twins.
What Increases Your Chance of Conceiving Twins?Twin pregnancies are more common in people who:Are older than 35 years oldHave a family history of twinsHave a partner with a twinHave conceived through in vitro fertilization (IVF)
What Increases Your Chance of Conceiving Twins?
Twin pregnancies are more common in people who:Are older than 35 years oldHave a family history of twinsHave a partner with a twinHave conceived through in vitro fertilization (IVF)
Twin pregnancies are more common in people who:
The first definitive symptom of any pregnancy is missing a period. While it may take awhile before you know you are carrying twins, there are some indicators.
What Are Mono Mono Twins?
People pregnant with twins have the normal symptoms of a single pregnancy, but oftentimes they are more pronounced.
For example, if you’re pregnant with twins, your human chorionic gonadotropin (hCG) levels will rise faster and higher than in a single pregnancy. More of this hormone makes nausea more severe. Fatigue and breast tenderness are other symptoms in the first trimester that may be worse than if you were pregnant with a single fetus.
Additionally, you will gain more weight, which puts more strain on your body as your pregnancy progresses, and can cause more exaggerated symptoms such as swelling and body aches.
Weight Gain for Twin PregnanciesGestational weight gain for twin pregnancies is as follows:37 to 54 pounds for normal-weight women31 to 50 pounds for women with overweight25 to 42 pounds for women with obesity
Weight Gain for Twin Pregnancies
Gestational weight gain for twin pregnancies is as follows:37 to 54 pounds for normal-weight women31 to 50 pounds for women with overweight25 to 42 pounds for women with obesity
Gestational weight gain for twin pregnancies is as follows:
It is important to keep your weight as close to these guidelines as possible through healthy eating and exercise to lessen the additional risks associated with having twins.
First Healthcare Provider’s Visit
Prenatal care is critical during pregnancy. If you conceive naturally, your first OB visit usually happens toward the end of your first trimester. If you conceive through IVF, you may see your healthcare provider sooner. Either way, the first major checkup usually happens toward the end of the first trimester (about nine to 12 weeks), even if you have seen your healthcare provider sooner than this. This visit may be when you learn that you are having twins.
During this appointment, your healthcare provider will review your health history, perform physical and pelvic exams, and give an overview for treatment during your pregnancy. Preparing a list of questions to ask your healthcare provider will help you remember them.
Most peoplle will also get the first ultrasound of their fetuses to check their heartbeats and anatomy. Your healthcare provider will run other tests to check for genetic abnormalities in the babies through bloodwork. Sometimes you may be offered a blood test that will reveal the sex of the fetuses. Your healthcare provider will calculate how many weeks pregnant you are and set a due date for the babies.
After the first visit, the standard schedule to see your OB-GYN is:
You may need to see your OB-GYN more frequently than the standard schedule.
Seeing a PerinatologistBecause having twins is considered ahigh-risk pregnancy, you will likely be referred to a perinatologist (high-risk obstetrics specialist or maternal fetal medicine specialist) to partner with your OB-GYN in your care.
Seeing a Perinatologist
Because having twins is considered ahigh-risk pregnancy, you will likely be referred to a perinatologist (high-risk obstetrics specialist or maternal fetal medicine specialist) to partner with your OB-GYN in your care.
Carrying two babies is more taxing on your body than a single pregnancy. A number of risks are associated with twin pregnancies, and a number of complications may occur. The following are the most prevalent.
Preterm Labor and Birth
Both being pregnant with twins and using assisted reproductive technology are associated with a higher risk of preterm labor and birth. One study showed that more than 50% of twin births occurred preterm, compared with only 10% of births of single babies.
Complications of preterm delivery depend on how early the babies are delivered. The earlier they are born, the higher the risk for complications. These can include:
Intrauterine Growth Restriction
Your healthcare provider may manage IUGR with:
When to deliver for a woman with IUGR will often depend on:
Preeclampsia
Preeclampsia is when a woman develops high blood pressure and a protein in her urine during pregnancy. There is a greater chance of preeclampsia with twin pregnancies. It also may occur earlier and be more severe in pregnancies with multiples.
Does Preeclampsia Go Away After Delivery?Preeclampsia usually starts any time after 20 weeks of pregnancy or after childbirth. This condition usually resolves shortly after birth.
Does Preeclampsia Go Away After Delivery?
Preeclampsia usually starts any time after 20 weeks of pregnancy or after childbirth. This condition usually resolves shortly after birth.
Preeclampsia can damage many organs in your body, most commonly:
Preeclampsia can also:
Because of the risks involved for mom and babies, when preeclampsia occurs during pregnancy, the babies may need to be delivered early even if they are not not full term.
Signs of preeclampsia include:
The U.S. Preventive Services Task Force recommends the use of daily low-dose aspirin (81 milligrams) after 12 weeks of pregnancy to help prevent preeclampsia in those at high risk.
Low Birth Weight
The two main causes of low birth weight are:
Complications for low birth weight babies include:
Nearly all low birth weight babies require time in the neonatal intensive care unit (NICU) until they weigh enough and are well enough to go home.
Gestational Diabetes
Gestational diabetes—which is high blood glucose (sugar) levels during pregnancy—impacts twin pregnancies more often than single pregnancies.
Pregnant women are routinely tested between 24 and 28 weeks for gestational diabetes because of the risks this condition poses. You may be screened earlier if you are at a higher risk for gestational diabetes. Risk factors include:
Uncontrolled blood sugar can cause complications during pregnancy for mothers and babies including:
In many cases, gestational diabetes can be managed through exercise and a healthy diet. However, some women will also require treatment with insulin.
Placental Abruption
The placenta attaches the fetuses to the mother’s uterus. It is a life source that gives food and oxygen to the fetuses through the umbilical cord. Placental abruption happens when the placenta separates from the uterus before birth. In most cases, the placenta stays attached to the uterus.
When placental abruption occurs, the uterus and all it provides is compromised. Placental abruption is an emergency and requires immediate care because it is life-threatening to the babies and potentially the mother. It can lead to:
About 1 out of 100 pregnancies has placental abruption. This condition usually happens in the third trimester, but it can also happen after 20 weeks of pregnancy.
The most common symptom is vaginal bleeding with pain during the third trimester of pregnancy. Sometimes the blood will be behind the placenta. In that case, there will be no bleeding. Symptoms also can include:
Twin-to-Twin Transfusion Syndrome
In twin-to-twin transfusion syndrome (TTTS), identical twins (or other multiples) share a placenta. Within the placenta, they share a network of blood vessels that supply nutrients and oxygen essential to survive and develop in utero.
When TTTS occurs, there is an unequal sharing of blood that passes between twins through blood vessel connections in the placenta. One twin (the donor twin) pumps blood to the other twin (the recipient twin). This causes the donor twin to receive too little blood and the recipient twin to receive too much.
This unequal distribution of blood and nutrients can lead to severe complications and even death in one or both twins. When the donor twin gives away more blood than it receives in return, the fetus runs the risk of:
The recipient twin receives too much blood and is at risk for cardiac complications, including hydrops.
Healthcare providers use the Quintero staging system to determine the severity of TTTS.
The Stages of TTTSStage I is the least severe stage. More than three-fourths of stage I cases remain stable or regress without invasive intervention. Survival is high at around 86%. Advanced TTTS (stage III and higher) has a high mortality rate at 70% to 100%, especially when TTTS presents at or before 26 weeks.
The Stages of TTTS
Stage I is the least severe stage. More than three-fourths of stage I cases remain stable or regress without invasive intervention. Survival is high at around 86%. Advanced TTTS (stage III and higher) has a high mortality rate at 70% to 100%, especially when TTTS presents at or before 26 weeks.
Treatment options include:
C-Section
C-sections are more common in twin pregnancies than single deliveries. This is because the conditions that raise the risk of C-section (low birth weight, gestational diabetes, preeclampsia, placental abruption, and IUGR) occur more often in women pregnant with twins.
However, twins are frequently delivered vaginally depending on factors relating to the presentation and gestation of the babies. Vaginal deliveries with twins are possible when:
C-sections are sometimes planned and sometimes not when there are emergency situations. There are some inherent risks associated with the surgery:
What You Need to Know About a Twin Pregnancy
A Word From Verywell
Pregnancy can be one of the most rewarding periods of a woman’s life. If you are pregnant with twins, it is important to maintain a close relationship with your healthcare provider to ensure the best outcomes for you and your babies.
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Cleveland Clinic.Preeclampsia.
U.S. Preventive Services Task Force.Aspirin use to prevent preeclampsia and related morbidity and mortality: U.S. Preventive Services Task Force recommendation statement.
Stanford Children’s Health.Low birth weight.
The American College of Obstetricians and Gynecologists.Gestational diabetes.
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Cleveland Clinic.Cesarean section (C-section).
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