The Risks of Pregnancy With Twins or Multiples

What are the real risks to mothers of multiples and their babies?

You've probably heard the term "high risk" associated with multiple pregnancy. It sounds threatening and scary, but don't let that dissuade you from educating yourself about the possible risks associated with having twins, triplets or more. Understanding the potential risks and complications, as well as the symptoms and treatment options, will make you better prepared to cope with the situation in the event you encounter problems in your pregnancy.

Some of the potential risks pose problems for the babies, while others impact the mother's health. Let's look at some of the risks for multiple babies:

Preterm Labor and Premature Birth

Perhaps the biggest risk associated with multiple birth is preterm labor, and consequently, premature birth. Mothers of multiples are twice as likely to experience preterm labor than their singleton peers. Preterm labor, the early onset of labor, can often be managed or even alleviated if the situation is addressed in a timely manner by medical professionals. Recognizing the signs of preterm labor is imperative.

Because of the increased potential for preterm labor and other complications, many twins and triplets, and nearly all quadruplets and higher order multiples are born prematurely. Prematurity impacts babies in a wide variety of ways, but fortunately, medical technology has advanced to a point where even the tiniest of babies can overcome the disadvantages of an early start in life.

Twin-to-Twin Transfusion Syndrome (TTTS)

Twin-to-Twin Transfusion Syndrome (TTTS) is a condition unique to monozygotic multiples that share a placenta. Blood vessels within the placenta become crossed, resulting in an unequal flow of blood betwen the babies.

One baby essentially becomes a donor to the other, recipent baby. It's dangerous for both babies, but does not impact the mother's health. Recent technological advances give doctors the ability to correct the situation with a special surgical procedure using lasers. For more information on treating TTTS, visit the TTTS Foundation website.

Monoamnionic Monochorionic (Mo-Mo) Twins

Only a small percentage of twins are affected by this condition. It occurs when monozygotic twins are enclosed within a single amniotic sac. As the pregnancy progresss, their umbilical cords become entangled and compressed, cutting off the flow of nutrients and oxygen to their developing bodies.

Unfortunately, there is no cure for the situation except to deliver the babies. Generally, mothers of Mo-Mo twins require careful monitoring and possibly hospitalization.

More About MoMo Twins

Other conditions associated with multiple pregnancy impact the mother's health. Read Page Two to find out more about those risks.

While some of the risks of multiple pregnancy only pose a danger to the babies, some conditions impact the mother's health. Aside from the physical strain and the emotional stress of carrying two, three or more babies, a mom of multiples may be susceptible to complications. In some cases, she may be at an increased risk for common complications of pregnancy, or she may experience more severe symptoms due to the additional babies.

Gestational Diabetes

Moms of multiples are more than twice as likely to experience gestational diabetes during their pregnancy with twins or more, probably because the increase in hormones produced by carrying an additional baby (or babies) interferes with their body's ability to process insulin. Often, it can be controlled with diet, but sometimes insulin must be administered. The condition does not pose a risk to the babies.

Placenta Problems

Whether there is a single, shared or multiple placentas, mothers of twins or more are at greater risk for complications such as placenta previa and placenta abruptio. Problems affecting the placenta can result in dangerous complications for the mother, including hemorrhage during pregnancy or after delivery. Fortunately, careful monitoring can detect most problems long before they pose a severe risk.

Heart Problems

A recent Canadian study suggests some sobering information about the dangers of multiple birth.

It found that women who carry two or more fetuses are thirteen times more likely to experience heart failure. Their risk of having a heart attack during pregnancy is nearly quadrupled. The researchers attributed the increase to physiological stress, explaining that each additional fetus raises the level of cardiac output.

It's not known how doctors will incorporate these recent research results into their treatment of multiple pregnancy.

Preeclampsia and PIH

Blood pressure problems plague many pregnant mothers of multiples. PIH, which stands for Pregnancy-Induced Hypertension, is diagnosed when a woman's blood pressure measures higher than 140 over 90. Your blood pressure should be checked regularly during your pregnancy; most medical caregivers take a reading at every office visit. Treatment options include restricted activity, bed rest, and occasionaly medications. Severe cases may require early delivery of the babies.

Elevated blood pressure is one component of a condition called preeclampsia. Preeclampsia differs from PIH when it is accompanied by proteinuria (protein in the urine).

Preeclampsia affects one in three moms of multiples during their pregnancy. In some cases it is treated with bedrest or medications, but should always be closely monitored becasue of the potential for serious complications like kidney failure, seizures or stroke. The condition is directly tied to pregnancy; if the babies are delivered, the preeclampsia goes away, usually without any lingering effects.

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