Pregnancy is an exciting and life-changing experience, but when you are carrying more than one baby, the situation becomes more complex. A multiple-gestation pregnancy, where a woman is pregnant with twins, triplets, or more, is considered high-risk.

Why is multiple-gestation pregnancy considered a high risk? There are several reasons that pregnancies involving multiple babies carry higher risks for both the mother and the babies.

At Rosh Maternal & Fetal Medicine, we understand that expecting multiples can bring both joy and uncertainty. Our team is dedicated to delivering expert, compassionate care tailored to your unique needs. We’ll walk you through the specific risks associated with multiple-gestation pregnancies and offer the support needed to promote the best possible outcomes for you and your babies.

What Is a Multiple-Gestation Pregnancy?

A multiple-gestation pregnancy occurs when a woman is carrying more than one fetus at a time. This can happen with twins, triplets, quadruplets, or even higher numbers. There are two main types of multiple pregnancies:

• Fraternal Twins (Dizygotic Twins): This happens when two separate eggs are fertilized by two separate sperm cells. Fraternal twins may or may not share a placenta.
• Identical Twins (Monozygotic Twins): This occurs when a single fertilized egg splits into two embryos. These babies will share the same genetic material, and in many cases, they will share a placenta.

While the majority of pregnancies are single-gestation, the rate of multiple pregnancies has risen in recent years, mainly due to fertility treatments, such as in vitro fertilization (IVF), which often involves transferring multiple embryos.

Increased Risk of Complications

A multiple-gestation pregnancy is considered high-risk due to the higher likelihood of complications that can affect the health of both the mother and the babies. These risks are more pronounced when there are three or more babies. However, even a twin pregnancy presents increased challenges.

Let’s take a look at some of the key risks.

• Preterm Birth

One of the most significant risks of a multiple-gestation pregnancy is preterm birth. Multiple babies place greater demands on the uterus, which leads to earlier labor and delivery. The average length of a pregnancy for twins is about 36 weeks, compared to the 40 weeks typical for a single baby. For triplets, the average is closer to 32-34 weeks.

Preterm birth can lead to complications for the babies, such as underdeveloped lungs, difficulty feeding, and other developmental delays. It is necessary to monitor a multiple-gestation pregnancy closely to manage the risk of preterm labor and intervene early when needed.

• Low Birth Weight

Low birth weight is another common risk in multiple-gestation pregnancies. Babies born prematurely or in multiple pregnancies tend to weigh less than those in single-gestation pregnancies. This can be due to factors like restricted space in the uterus or earlier-than-expected delivery.

Low birth weight can lead to complications, including:

• Respiratory issues: Babies with low birth weight may have underdeveloped lungs.
• Feeding difficulties: Babies born prematurely may have trouble sucking and swallowing.
• Increased risk of infections: Weaker immune systems in premature babies may make them more vulnerable to infections.

We work closely with expectant mothers carrying multiples to monitor fetal growth and plan for the best possible care during delivery.

• Preeclampsia

Preeclampsia, a condition characterized by high blood pressure and damage to organs such as the kidneys and liver, is more common in women carrying multiple babies. Women carrying twins are two to three times more likely to develop preeclampsia compared to women with a single pregnancy.

Preeclampsia can affect both the mother and the babies. If left untreated, it can lead to severe complications, including stroke, organ failure, or placental abruption (when the placenta detaches from the uterus).

Managing preeclampsia involves frequent monitoring of blood pressure, urine tests, and blood tests to check for protein or other signs of kidney damage.

• Gestational Diabetes

Women carrying multiple babies face a higher risk of developing gestational diabetes. This condition occurs when the body cannot produce enough insulin during pregnancy, leading to elevated blood sugar levels.

Gestational diabetes can cause complications such as:

• Large babies (macrosomia): High blood sugar levels can lead to excessive growth of the baby, increasing the risk of birth injuries during delivery, such as shoulder dystocia.
• Preterm birth: Women with gestational diabetes are more likely to deliver early.
• Low blood sugar in babies after birth: Babies born to mothers with gestational diabetes are at risk for hypoglycemia, which can cause serious complications if not managed properly.

Managing gestational diabetes typically involves dietary changes, blood sugar monitoring, and in some cases, insulin injections.

• Placental Issues

Placental issues are more common in multiple-gestation pregnancies. These can include:

• Placenta previa: This occurs when the placenta covers the cervix and makes vaginal delivery impossible. It is more common in multiple pregnancies, especially when the babies share a placenta.
• Placental abruption: This is when the placenta separates from the uterine wall prematurely, which can cause heavy bleeding and deprive the baby of oxygen and nutrients. It can be more common in women carrying multiples.

Close monitoring through ultrasounds and fetal heart rate monitoring is necessary to detect any placental issues early and determine the safest course of action for delivery.

• Twin-to-Twin Transfusion Syndrome (TTTS)

In pregnancies where twins share a placenta, there is a rare but serious condition called twin-to-twin transfusion syndrome (TTTS).

In TTTS, blood flow between the twins becomes unbalanced, with one twin receiving too much blood while the other receives too little. This can lead to severe complications for both babies, including heart failure, organ damage, or even death if not treated.

TTTS can be diagnosed through ultrasounds and requires careful monitoring. In some cases, treatment such as laser surgery to correct the blood flow imbalance may be necessary.

• Higher Risk for Cesarean Delivery

Multiple-gestation pregnancies have a higher likelihood of resulting in a cesarean delivery (C-section). The increased size of the uterus and the higher likelihood of complications like preterm labor or abnormal positioning of the babies can make vaginal delivery more difficult and riskier.

A cesarean delivery carries its own risks, including longer recovery times for the mother, increased blood loss, and complications with future pregnancies. It is important to discuss your delivery plan with your OB/GYN to secure the best possible outcome for both you and your babies.

• Increased Medical Costs and Hospital Stays

Multiple-gestation pregnancies are often associated with longer hospital stays, more frequent doctor visits, and additional medical interventions, which can result in higher medical costs.

Women carrying multiples will need closer monitoring and more prenatal care. Hospital stays may also be longer if the babies are born prematurely or have health complications that require specialized care in a neonatal intensive care unit (NICU).

Managing a Multiple-Gestation Pregnancy

Rosh Maternal & Fetal Medicine knows the importance of closely monitoring multiple-gestation pregnancies to guarantee the health of both the mother and the babies. Here are a few ways we manage high-risk pregnancies:

• Frequent Checkups: Women carrying multiples will have more frequent prenatal visits to monitor fetal growth, blood pressure, and any potential complications.
• Ultrasound Monitoring: We use ultrasounds to monitor the babies’ positions, placental health, and signs of complications like TTTS or growth restriction.
• Customized Care Plans: Each multiple-gestation pregnancy is unique. For this reason, we create personalized care plans based on the mother’s health, the number of babies, and the presence of any complications.
• Delivery Planning: We will help plan the delivery to ensure the safest outcome, whether that involves a vaginal delivery, a cesarean section, or specialized care for premature babies.

Monitoring a Multiple-Gestation Pregnancy

When you’re pregnant with multiples, the level of care you require will differ from that of a singleton pregnancy. Multiple pregnancies are high-risk because they place added strain on both the mother’s body and the developing babies. We understand that managing these risks requires both expertise and support.

Below are some of the ways we monitor and manage a multiple-gestation pregnancy.

• Frequent Prenatal Appointments

Women carrying multiples often require more frequent visits to their OB/GYN. These appointments are vital for ensuring the health of both the mother and the babies.

With a multiple-gestation pregnancy, regular checkups allow us to monitor the development of each baby and assess any changes in the mother’s health. The increased number of babies in the uterus means that there is a greater need for careful monitoring.

Frequent prenatal visits help detect any potential complications early on, which can be addressed promptly. This includes monitoring for signs of preeclampsia, gestational diabetes, or other issues that may arise. These visits also allow us to track fetal growth, check the babies’ positions, and assess the overall well-being of both the mother and babies.

• Ultrasound Monitoring

Ultrasound is one of the most important tools we use to monitor a multiple-gestation pregnancy. It helps us track fetal growth, check for complications like twin-to-twin transfusion syndrome (TTTS), intrauterine growth restriction (IUGR), and assess the babies’ positions. We may schedule more frequent ultrasounds than in a singleton pregnancy to guarantee proper development and positioning.

• Blood Tests and Screening

Women pregnant with multiples may have a higher risk for conditions like gestational diabetes, anemia, and hormonal imbalances.

Blood tests conducted throughout your pregnancy help track key health indicators. This allows early detection of potential issues and supports timely adjustments to your care plan to promote a healthy pregnancy.

• Preparing for Delivery

As your pregnancy progresses, delivery becomes a focal point. Multiple-gestation pregnancies typically require a specialized approach to guarantee the best outcome for both mother and babies.

At Rosh Maternal & Fetal Medicine, we begin discussing your delivery plan well before your due date. This allows us to anticipate potential complications and prepare accordingly.

Important factors in a multiple-gestation delivery plan include the possibility of a cesarean section, preterm labor, and neonatal intensive care unit (NICU) support for premature births. We work with you to create a flexible plan, ensuring that we are prepared for any situation that may arise during delivery.

Postpartum Care and Recovery

After delivering multiple babies, the recovery process can be more challenging than after a single-birth pregnancy.

• Physical Recovery

After a multiple-gestation pregnancy, you may experience a longer recovery time due to the added strain of carrying more than one baby. The increased weight and pressure on the body can lead to more discomfort, including abdominal soreness, lower back pain, and pelvic pressure.

It is common to feel more fatigued and emotionally drained than after a single-baby pregnancy, as your body works harder to recover from the physical changes. The recovery process may take longer, especially if you had a cesarean section, as the body needs time to heal from the surgery and adjust to its new state.

• Mental and Emotional Health

It is not uncommon for mothers with multiple pregnancies to feel overwhelmed or anxious, especially when it comes to caring for multiple babies. You will need support from your family, healthcare providers, and community.

Postpartum depression is something to watch for, especially in high-risk pregnancies. Please do not hesitate to reach out for help if you are feeling anxious or overwhelmed.

• Follow-Up Appointments

Your postpartum care will include several follow-up visits to ensure you are healing properly. These visits allow your OB/GYN to check your physical recovery, monitor for signs of complications, and help you with any breastfeeding or newborn care challenges. We will work with you to provide the support you need during this transition.

A multiple-gestation pregnancy may come with more risks, but that doesn’t mean it has to be a daunting experience. With proper care, close monitoring, and expert guidance, you can have a healthy pregnancy and a positive experience welcoming your babies. Rosh Maternal & Fetal Medicine is committed to supporting you every step of the way.

This is not medical advice, and the patient must contact their provider before making any health decisions.

If you are pregnant with multiples or if you have any concerns about your high-risk pregnancy, contact us today. Our team of specialists is here to help guide you through this special time with expert care and compassionate support.