What to Know About Pregnancy With Triplets

Many women look forward to becoming pregnant and starting or growing their family. Most of the time, you don’t expect to see three tiny fetuses on your ultrasound. But if you do, here’s what you need to know about triplet pregnancy. 

What Causes Triplet Pregnancies?

If you’re pregnant with more than one baby, it is often referred to as multiples. Pregnancies of more than one child represent approximately three in 100 births. If more than one egg is fertilized and implants in the uterus, your multiples are fraternal. If one egg is fertilized and splits before implanting in the uterine lining, you have identical multiples. In triplets — or any multiples more than two — the siblings can be all fraternal, all identical, or a combination of both.

There are several factors that increase your chances of being pregnant with more than one baby: 

  • Heredity. If you have a family history of multiple babies during pregnancy, it’s more likely that you will have twins or triplets.
  • Age. If you’re older than 30, there’s a greater chance you’ll have multiples.
  • Previous pregnancies. If you’ve been pregnant at least once before, you’re more likely to have a multiple pregnancy your second or third time. This is especially true if you previously gave birth to twins or triplets.
  • Race. African American women are more likely than any other race to have a multiple pregnancy. Asian and Native American women are the least likely. White women who are older than 35 have the highest rate of multiple births that are more than twins (triplets, quadruplets, etc.).
  • Ovulation-stimulation medicine. Medications like clomiphene citrate and follicle-stimulating hormone (FSH) help your body produce eggs. These are often used for low fertility but can lead to a triplet pregnancy if multiple eggs are released and fertilized. 
  • In vitro fertilization (IVF). This and other similar treatments help parents get pregnant by fertilizing eggs in a lab and then returning them to the uterus to grow. IVF pregnancies are more likely to produce multiples than natural pregnancies.

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Risks Associated With Triplet Pregnancies

Premature birth. The greatest risk in carrying triplets is your babies being born prematurely. In fact, 60% of all multiple pregnancies occur before 37 weeks of gestation. The average gestation for a triplet pregnancy is even lower, at 32 weeks.

Delivery. Many triplet pregnancies end in a cesarean section for the safety of the babies and the mother. The probability of a vaginal delivery depends on:

  • Size of each baby
  • Positions of the babies
  • Health of the babies
  • Size and shape of the mother’s pelvis 

During pregnancy, it is important to be aware of the signs of premature labor:

  • Pelvic pressure
  • Lower back pain
  • Significant vaginal discharge
  • Change in frequency or intensity of contractions

If you suspect you are experiencing premature labor, contact your doctor immediately. If caught early enough, the labor can be stopped so your babies have longer to grow.

Placenta. The placenta is an organ that attaches to the wall of the uterus and transfers blood, oxygen, and nutrition from mother to baby through the umbilical cord. When a placenta supports more than one baby, it ages faster, limiting your babies’ growth potential.

The placenta may also provide imbalanced nutrients to each baby, causing one to grow larger while another remains smaller.

Preeclampsia. Preeclampsia is a dangerous condition when your blood pressure gets too high during pregnancy, putting you at risk for seizures. You’re at a much higher risk for preeclampsia with triplets. Symptoms of preeclampsia include:

Diabetes. Gestational diabetes is very common in women with triplet pregnancies. However, it is also common in pregnancies of only one baby, so it is well known and easy to manage. 

Newborn complications. The average weight at birth for triplets is just under 4 pounds. Approximately 20% of triplet pregnancies result in one child having a life-long handicap of some sort. Preterm delivery means an increased risk that your baby’s lungs, eyes, brain, circulatory system, and intestinal system are not fully developed yet.

It is likely that your babies will require a stay in the neonatal intensive care unit (NICU) where any complications will be treated, and they can thrive and grow. 

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What Triplet Pregnancies Are Like for the Mother

Due to the greater risks associated with pregnancy with triplets, you will need more medical care during your pregnancy. Even if everything goes well, you should still be seeing your doctor more often to check for issues with your babies.

You are more likely to experience common pregnancy symptoms like reflux, hemorrhoids, constipation, back pain, and varicose veins. You will also grow bigger more quickly, which may mean you need supplements or a specific nutrition plan. Talk to your doctor to create a plan for your triplet pregnancy.

WebMD Medical Reference Reviewed by Dan Brennan, MD on March 11, 2021

Sources

SOURCES:

American Society for Reproductive Medicine: “Multiple Pregnancy and Birth: Twins, Triplets, and High Order Multiples.”

Cleveland Clinic: "Expecting Twins or Triplets."

Harvard Health: “Preeclampsia And Eclampsia.”

Pregnancy, Birth and Baby: “Multiple pregnancy (triplets or more).”
Stanford Children’s Health: “Overview of Multiple Pregnancy.”

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