Always be sure to take extra good care of yourself when you are pregnant. When carrying twins or more (multiple pregnancy), be sure to eat a balanced and nutritious diet of quality calories. And make sure that you get enough calcium, iron, and folic acid.
You can expect to gain weight more quickly than you would with one fetus. With each additional fetus a woman carries, her range of weight gain will increase. Your range of healthy weight gain will also be different if you started your pregnancy underweight or overweight.
Prenatal care during a multiple pregnancy
If you are pregnant with twins or more, good prenatal care will help you and your health professional prevent and watch for problems. You will have more frequent checkups than you would for a pregnancy with one fetus. These checkups are important both for monitoring your own health and your fetuses' health and for giving you and your health professional time to build a working relationship.
Because you are more likely to deliver early, be sure to plan ahead. Ask your health professional about making arrangements to deliver at a hospital that has facilities for emergency cesarean delivery and a neonatal intensive care unit (NICU).
Watch for problems
Possible pregnancy problems that can be more likely when you are carrying twins or more include:
- Preeclampsia and high blood pressure. Treatment depends on how severe your condition becomes. It may include medicine, bed rest, fetal monitoring, and early delivery. For more information, see the topic Preeclampsia and High Blood Pressure During Pregnancy.
- Problems with the placenta, such as placenta abruptio or placenta previa. For more information, see Placenta Abruptio and Placenta Previa.
- Anemia, which is treated with iron-rich foods and iron supplements. If this doesn't help, you can be tested for other problems that can cause anemia.
- Too much amniotic fluid in the uterus (polyhydramnios). Treatment can include medicine and removal of amniotic fluid.
- Urinary tract infection (UTI), which is treated with antibiotics.
- Heavy blood loss after delivery (postpartum hemorrhage), which can require a blood transfusion.
- The need to deliver by cesarean section (C-section). You will likely need a C-section if your babies (fetuses) are not turned head-down in time for birth (breech or transverse fetus ).
Any pregnancy can have these complications, but there is more concern about them happening during a multiple pregnancy.
Preterm labor is more common in a multiple pregnancy than in a pregnancy with one fetus. If you go into preterm labor and premature delivery is likely, your health professional may recommend taking one or more precautions, such as:
- Limiting your activity level.
- Staying in the hospital. This is often so that you can receive steroid medicine to help your babies' lungs develop faster. In some cases, tocolytic medicine is used in an attempt to delay preterm birth. You are closely watched if you are treated with a tocolytic medicine.
For more information, see the topic Preterm Labor.
Possible problems for the babies (fetuses) during multiple pregnancy can include vanishing twin syndrome, twin-to-twin transfusion, twins that share one amniotic sac (monoamniotic twins), and locking twins.
Early pregnancy decisions about triplets or more
When there are three or more fetuses in the uterus, their risks of disability or death are higher with each additional fetus. If you are carrying triplets or more after infertility treatment, your doctor may offer the option of multifetal pregnancy reduction (MFPR) near the end of your first trimester. A successful MFPR increases the chances of healthy survival for the remaining fetuses and reduces risks to you. But MFPR sometimes leads to miscarriage.1
The decision to have a multifetal pregnancy reduction is difficult and may be traumatic. If you are faced with this decision, talk to your doctor about your personal risks from trying to carry multiple fetuses to term compared to the risks of choosing MFPR. Also consider discussing your decision with a counselor or spiritual adviser.