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Pregnant with Twins

Pregnant with Twins

What to Expect

There are two things in life for which we are never truly prepared: twins.
Josh Billings

Learning that you are pregnant with twins brings with it a world of mixed emotions – shock, disbelief, joy and amazement. Once these emotions settle you will most likely be faced with many questions and concerns. This article strives to provide answers to the questions most commonly asked by moms pregnant with twins. We trust these will help to set your mind at ease.

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Weight gain in any pregnancy is dependant on a variety of factors, including the mother’s height and body shape, how much she weighed when she fell pregnant and her eating habits. Mothers of twins do generally gain more weight than those pregnant with one baby, and this can cause some discomfort in the third trimester. Consistent weight gain is especially important in the second trimester as this helps to reduce the incidence of low birth weight. However, both excessive and insufficient weight gain are unhealthy and your doctor or midwife will keep a close eye on the situation as your pregnancy progresses to ensure your health and that of your babies.

If you suddenly gain a lot of weight in a short space of time, consult your doctor or midwife, as this may be an early sign of pre-eclampsia, a disorder that places both the mother and the unborn baby at risk. It is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine.

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The majority of pregnant women experience some morning sickness – although not always in the morning. Moms of twins will not necessarily face a double dose, but since morning sickness is triggered by the pregnancy hormone human chorionic gonadotropin (hCG), and levels of this hormone are higher when expecting twins, increased morning sickness is relatively common.

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Extreme fatigue is the most commonly reported complaint during twin pregnancies. During the first trimester, your body has to work double time to nurture both babies, with the result that you will become tired easily. As the babies grow, the added stress on your body makes extra rest essential. Back pain is also often associated with coping with the additional weight of a twin pregnancy.

You may experience shortness of breath in the early stages of pregnancy. This is caused by higher levels of the hormone progesterone. As the babies grow and push up against your diaphragm, you may feel breathless and fatigued.

In every pregnancy, blood volume increases, and even more so with twins. This means that mom’s blood is diluted and has fewer oxygen-carrying red blood cells.  Maternal anaemia is therefore very common when twins are expected, leaving mom feeling extremely exhausted and listless. Eat plenty of iron-rich foods and if you do become anaemic, discuss taking iron supplements with your doctor or midwife.

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A healthy, balanced diet is the cornerstone of every pregnancy – essential to the optimal growth and development of the foetus. Although you don’t need to double the quantity of food you eat when carrying twins, you must ensure that you increase your nutritional intake, especially protein, as this will help to build a good placenta and strong amniotic sac. Also, ensure that you consume sufficient amounts of calcium. Low birth weight is a common problem with multiple pregnancies, but following a nutritious diet can help reduce this risk. If you are particularly active, be sure to increase your calorie intake accordingly.

The increased amount of pregnancy hormones causing havoc with your system may mean you experience increased nausea, indigestion and constipation. Eating small portions more often may help and your doctor or midwife will be able to offer advice as to dealing with these discomforts.

It is important to supplement your diet with 400 micrograms of folic acid a day for the first 12 weeks of your pregnancy. Your doctor or midwife may also recommend that you take a daily pregnancy multivitamin and an omega-3 pregnancy supplement.

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A multiple pregnancy is considered higher risk, so choose your doctor or midwife carefully, ensuring that they have previous experience and special expertise in dealing with multiple births. You will more than likely have more antenatal appointments and more ultrasound scans. Ensure that you stick to your appointment schedule, as constant medical monitoring will ensure that any complications are detected early. Your medical practitioner will monitor you for any signs of diabetes, pre-eclampsia and anaemia.

Blood screening tests for Down syndrome and other genetic abnormalities are less effective with multiple pregnancies. From 11 to 13 weeks of pregnancy you will be offered a nuchal translucency (NT) scan – a non-invasive test to assess your risk of having a Downs baby.

If your twins are identical, the amount of care you’ll receive depends on whether they share a placenta and/or an amniotic sac.  If they share a placenta (monochorionic) but have their own sacs (diamnotic), you’ll be seen more regularly as there is a higher risk of certain complications including twin-to-twin transfusion syndrome (TTTS). (see below)

During the last trimester, you will have more frequent scans to monitor the growth and position of your babies and placenta(s).

Remember that your body is under enormous strain when carrying twins and the best thing you can do for yourself and your babies is to get plenty of rest. Don’t be afraid to accept help when it’s offered – you are going to need your strength when your babies arrive.  Prepare your body for labour by keeping fit with gentle exercises such as swimming, walking, yoga and Pilates and remember to do pelvic floor exercises regularly.

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Most multiple pregnancies progress smoothly, resulting in the birth of healthy babies. However, multiple pregnancies do carry a higher risk of complications developing. At particular risk are identical or monochorionic (MC) twin pregnancies in which the twins share a placenta. In this situation, there are vascular connections in the placenta shared by the two foetuses. These connections can cause an imbalance in the circulations of the foetuses to develop (in about 15% of cases). In these instances, there may be a significant transfer of blood from the ‘donor’ twin to the ‘recipient’ twin, resulting in twin-twin transfusion syndrome (TTTS). Over time, the recipient foetus receives too much blood, which can overload the cardiovascular system and cause too much amniotic fluid to develop. The smaller donor foetus does not get enough blood and has low amounts of amniotic fluid. Although there are other problems unique to MC twin pregnancies, TTTS is the most common.

The most common complications associated with twin pregnancies are:

Preterm labour and birth

Almost 60 percent of twins are born premature, that is before 37 weeks. Premature babies are often small, with low birth weights and they may need a bit of help breathing, eating, fighting infection, and staying warm.

Pregnancy-induced high blood pressure or gestational hypertension

This condition occurs in a quarter of multiple pregnancies and can increase the risks of early detachment of the placenta (placental abruption).

Placental abruption

A potentially serious condition in which the placenta detaches from the wall of the uterus before delivery. This condition is often linked to malnutrition, smoking and drug use.


This serious condition is almost three times as likely to occur if you are carrying twins and places both the mother and baby at risk of illness and even death.


Anaemia is more than twice as common in multiple pregnancies as in a single births, but is relatively easily controlled.

Birth defects

Multiple birth babies are twice as likely to have congenital abnormalities such as neural tube defects and abnormalities of the heart.


Vanishing twin syndrome occurs when one foetus vanishes, or is miscarried, usually in the first trimester. Bleeding may occur. There is also an increased risk of pregnancy loss in later trimesters.

Abnormal amounts of amniotic fluid

Amniotic fluid abnormalities are more common in multiple pregnancies, especially for twins that share a placenta.

Caesarean delivery

Many twins are delivered perfectly safely vaginally, but sometimes there are factors present that make caesarean delivery necessary, such as the position of the babies and how well they handle the progression of labour. If the babies are in a position where neither can move, they will have to be born via caesarean. Breech babies depend on the size of the babies and the skill of the practitioner.

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