Alia Bucciarelli, MS
A multiple pregnancy is when a woman is pregnant with 2 or more fetuses. Twins are the most common type of multiple pregnancy. So-called “higher-order” pregnancies (when a woman is carrying triplets, quadruplets, quintuplets, or more) are less common.
The risk for certain complications during and after pregnancy is higher in multiple pregnancies. To lessen these risks, your doctor will see you more often than a woman carrying 1 baby.
Multiple pregnancies occur when a single fertilized egg divides and develops into 2 or more fetuses (identical twins) or when more than 1 egg is fertilized by a different sperm (fraternal twins). Triplets, quadruplets, and quintuplets can be identical, fraternal, or a combination of both.
Multiple pregnancy is more common in women of African ancestry. It is also more common in women over 30.
Factors that may increase your changes of having a multiple pregnancy include:
Symptoms include the following:
You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor may refer you to a healthcare professional who has experience with multiple pregnancies.
Most multiple pregnancies are discovered during an
examination. An ultrasound examination is a test that uses sound waves to see how the fetus is developing.
Other tests that may detect a multiple pregnancy include:
Multiple pregnancies have a greater risk for certain complications. If you experience any of these conditions, your doctor will discuss the best treatment plan for you.
Most multiple births are preterm (before the end of 37 weeks of pregnancy). Babies born preterm have a higher risk for many health problems. To delay preterm birth, your doctor may suggest bed rest at home or in a hospital or prescribe certain medications. If labor threatens to occur before 34 weeks of pregnancy, you may be given steroid medication to help your babies’ lungs mature.
is a disorder in which the body becomes less sensitive to insulin resulting in high blood sugar levels. Gestational diabetes treatment aims to return blood sugar levels to normal through diet, exercise, blood sugar level testing, and sometimes insulin shots.
is a condition occurring during pregnancy when a woman has high blood pressure and more than normal amounts of protein in her urine. Treatment may include drugs, rest, and early delivery of the babies.
More than 1 fetus in the uterus increases the chance that 1 of them will be unable to turn head down. A
or transverse presentation increases the chance of needing a
Twins sometimes share vessels in the placenta. If this sharing is unequal, this syndrome can develop. In TTTS, 1 twin transfuses (donates blood) to the other. The donor twin becomes anemic and the receiving twin develops problems of having too much blood and fluid in the body.
More than 1 fetus in the uterus increases the chance of
postpartum hemorrhage. This is heavy blood loss in the mother after delivering the babies.
To help reduce your chance of having health problems during a multiple pregnancy, take the following steps:
American Congress of Obstetricians and Gynecologists
March of Dimes
The Society of Obstetricians and Gynaecologists of Canada
Multiple births. Centers for Disease Control and Prevention website. Available at:
http://www.cdc.gov/nchs/fastats/multiple.htm. Updated February 2, 2016. Accessed April 7, 2016.
Multiple gestations: complicated twins, triplets and high-order multifetal pregnancies.
The American Congress of Obstetricians and Gynecologists, Practice Bulletin No. 56. October 2004 (Reaffirmed 2009).
Multiple pregnancy. American College of Obstetricians and Gynecologists website. Available at:
http://www.acog.org/Patients/FAQs/Multiple-Pregnancy. Published July 2015. Accessed April 7, 2016
Multiples: twins, triplets, and beyond. March of Dimes Birth Defects Foundation website. Available at:
http://www.marchofdimes.com/pregnancy/multiples-twins-triplets-and-beyond.aspx. Updated June 2015. Accessed April 7, 2016.
Preparing for multiple births. Kids Health–Nemours Foundation website. Available at:
http://kidshealth.org/parent/pregnancy_newborn/pregnancy/multiple_births.html. Updated October 2013. Accessed April 7, 2016.
Last reviewed April 2016 by Andrea Chisholm, MD
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