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11 Things You Didn't Know About Twin Pregnancies

Experts share their advice for women who are pregnant with twins.

No. 5: Spotting may be more common during twin pregnancies.

"When you spot in the first trimester, you could be undergoing a miscarriage, and miscarriages are more common in mothers of twins, triplets, and quadruplets -- so we see more spotting in first trimester with multiples," Al-Khan says.

But a little spotting is no reason to hit the panic button even in twin pregnancies. "A little spotting in the absence of cramps is reassuring, but when you are cramping, passing clots, and actively bleeding, that is a sign that's something is happening and you should seek medical advice."

No. 6: You don't feel the babies kicking any earlier with twin pregnancies.

"Generally when you are pregnant with twins, fetal movements become more noticeable at weeks 18 through 20 of pregnancy, and the same is true in singleton pregnancies," Al-Khan says. When a woman begins to feel fetal movements actually depends on whether she has been pregnant before. "If you have been pregnant before, you know what fetal movement is, but if you are pregnant for the first time, you really can't distinguish the movement from gastrointestinal activity."

No. 7: Moms pregnant with twins may gain more weight than moms carrying one child.

"With twins, mothers gain more weight as there are two babies, two placentas, and more amniotic fluid," says Al-Khan. "You also need more calories for twin pregnancies."

Still, there is not a well-established formula for weight gain during twin pregnancies, says Monga. "The average weight gain is 25 pounds for singleton pregnancy and 30-35 pounds for twins. We don't want moms pregnant with twins to gain more than 40 [pounds] or less than 15 pounds."

The Institute of Medicine's provisional guidelines for weight gain in women expecting twins say:

  • Women of normal weight should aim to gain 37-54 pounds
  • Overweight women should aim to gain 31-50 pounds 
  • Obese women should aim to gain 25-42 pounds

Exactly how much weight should you gain? The IOM recommends that you talk to your health care provider about that, because every pregnancy is unique.  

No. 8: Risk of developing gestational diabetes is higher in twin pregnancies.

"The gestational diabetes risk is higher in twin pregnancy," says Monga. That said, the biggest risk of gestational diabetes is having larger babies and requiring a C-section delivery, she says.

"While gestational diabetes is more common, the morbidity associated with it is less common because twin babies are not big babies."

Still, moms who develop gestational diabetes during pregnancy are more likely to develop type 2 diabetes later in life, she says.

No. 9: Risk of preeclampsia during pregnancy is higher in twin pregnancies.

"People really don't know what causes preeclampsia to start, but we know it occurs more frequently in twin pregnancies," Monga says. Preeclampsia is marked by high blood pressure, protein in the urine, and sometimes swelling in the feet, legs, and hands. It is the precursor to the more serious, potentially fatal eclampsia.

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