If you're anticipating twins and curious about the experience, it's a feeling shared by many. Discovering you're expecting two babies often happens unexpectedly. While envisioning how it will impact your daily routine might be challenging, there's plenty to understand before the twins arrive.
A twin pregnancy is indeed a double blessing, yet it also entails higher risks compared to singleton pregnancies.
Familiarize yourself with these aspects of twin pregnancies from conception to delivery.
1. In your 30s and 40s, the likelihood of naturally conceiving twins increases.
As we age, conception can become more challenging, yet it might increase the chances of a twin pregnancy, according to Abdulla Al-Khan, MD, director and chief of maternal and fetal medicine and surgery at Hackensack University Medical Center in New Jersey. "Once you're 25 or older, irregular ovulatory cycles can occur. If ovulation happens irregularly and simultaneously involves two follicles, a twin pregnancy can result without the need for assisted reproductive technologies."
2. Expecting twins may necessitate additional folic acid intake to prevent birth defects, advises Manju Monga, MD, division director of maternal-fetal medicine at the University of Texas Health Sciences Center in Houston.
"We recommend 1 milligram of folic acid daily for twin pregnancies, compared to 0.4 milligrams for singleton pregnancies," says Monga, who is herself a mother of twins. Folic acid helps lower the risk of neural tube defects like spina bifida.
3. Pregnancy with twins entails more frequent visits to the doctor.
"Twin pregnancies require more monitoring than single pregnancies," Monga explains. "We conduct more frequent ultrasounds to monitor growth, whereas a singleton pregnancy typically involves one anatomy scan and one growth scan."
4. Morning sickness tends to be more severe in twin pregnancies due to higher levels of human chorionic gonadotropin, explains Al-Khan. "This hormone is linked to nausea and vomiting, which are more prevalent in the first trimester of twin pregnancies." Fortunately, most morning sickness subsides by 12 to 14 weeks, even in twin pregnancies.
Additionally, Monga notes that women expecting twins often experience increased back pain, difficulty sleeping, and heartburn compared to those carrying a single child. Twin pregnancies also carry a higher incidence of maternal anemia and postpartum hemorrhage following delivery.
5. Spotting during the first trimester is more common in twin pregnancies, which could indicate a higher risk of miscarriage, as multiples pregnancies have a higher rate of miscarriage.
6. Feeling fetal movements in twin pregnancies typically becomes noticeable around weeks 18 to 20, similar to singleton pregnancies, explains Al-Khan.
First-time pregnancies may find it challenging to distinguish fetal movement from gastrointestinal activity until they become more familiar with the sensation.
7. Expectant mothers of twins often gain more weight due to supporting two babies, two placentas, and increased amniotic fluid, according to Al-Khan.
The calorie requirements are also higher for twin pregnancies. However, Monga emphasizes that there isn't a set formula for weight gain in twin pregnancies. While singleton pregnancies average a 25-pound gain, twins may lead to a 30-35 pound increase. It's important for moms expecting twins to gain between 15 and 40 pounds, depending on their pre-pregnancy weight, as advised by the Institute of Medicine.
8. The risk of developing gestational diabetes is elevated in twin pregnancies, warns Monga.
Although twins are generally not born large, gestational diabetes can lead to bigger babies and an increased likelihood of requiring a C-section. Additionally, experiencing gestational diabetes during pregnancy raises the risk of developing type 2 diabetes later in life.
9. Twin pregnancies are associated with a higher risk of preeclampsia, states Monga.
The exact cause of preeclampsia remains unknown, but it occurs more frequently in twin pregnancies. Preeclampsia is characterized by high blood pressure, protein in the urine, and swelling in the extremities, and can progress to eclampsia, a serious and potentially fatal condition.
10. Twin pregnancies often lead to earlier labor and delivery.
"Most women carrying twins go into labor around 36 to 37 weeks, compared to the typical 40 weeks for single pregnancies," explains Al-Khan. "Some twins may even arrive earlier. Babies born after 34 weeks generally have fewer concerns, but premature birth still poses risks, including respiratory issues and low birth weight."
Managing preterm labor in twin pregnancies is challenging, as bed rest alone hasn't been proven effective in preventing early delivery, and medications to stop preterm labor may not reliably work, according to Al-Khan.
11. Cesarean section deliveries are more common with twin pregnancies.
"The likelihood of needing a C-section is higher in twin pregnancies," Al-Khan notes. "Twins also have a higher incidence of being in breech position compared to singletons, which often necessitates a C-section."
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