This topic is for women who are pregnant with more than one baby. It focuses on the questions that are specific to multiple pregnancies. For information on what to expect during pregnancy, labor, and childbirth, see the topic Pregnancy.
A multiple pregnancy means that a woman has two or more babies in her uterus. These babies can come from the same egg or from different eggs.
Babies that come from the same egg are called identical. This happens when one egg is fertilized by one sperm. The fertilized egg then splits into two or more embryos. Experts think that this happens by chance. It isn't related to your age, race, or family history.
If the babies you're carrying are identical, they:
Babies that come from different eggs are called fraternal. This happens when two or more eggs are fertilized by different sperm. Fraternal twins tend to run in families. This means that if anyone in your family has had fraternal twins, you're more likely to have them too.
If the babies you're carrying are fraternal, they:
See a picture of identical and fraternal babies in the uterus.
Fertility drugs help your body make several eggs at a time. This increases the chance that more than one of your eggs will be fertilized. When in vitro fertilization is used to help a woman get pregnant, the doctor may put several fertilized eggs in the uterus to increase the chances of having at least one baby. But this also makes a multiple pregnancy more likely.
You're also more likely to have more than one baby at a time if:
Any pregnancy has risks. But the chance of having serious problems increases with each baby you carry at the same time.
If you're pregnant with more than one baby, you may be more likely to:
Keep in mind that these problems may or may not happen to you. Every day, women who are pregnant with more than one baby have healthy pregnancies and have healthy babies.
While you may feel like you're carrying more than one baby, only your doctor can say for sure. He or she will do a fetal ultrasound to find out. This test can give your doctor a clear picture of how many babies are in your uterus and how well they're doing.
If the test shows that you're carrying more than one baby, you'll need to have more ultrasounds during your pregnancy. Your doctor will use these tests to check for any signs of problems that your babies may have as they grow.
If you're pregnant with more than one baby, you'll need to see your doctor more often than you would if you were having just one baby. This is because you and your babies have a greater chance of developing serious health problems.
Your doctor will do a physical exam at each visit. It's important that you go to every appointment. Your doctor may also do a fetal ultrasound, check your blood pressure, and test your blood and urine for any signs of problems. Early treatment can help you and your babies stay healthy.
The thought of having more than one baby may be scary, but it doesn't have to be. There are some simple things you can do to keep you and your babies healthy.
The best thing you can do is take care of yourself. The healthier you are, the healthier your babies will be.
While you're pregnant, be sure to:
After your babies are born, you may feel overwhelmed and tired. You may wonder how you're going to do it all. This is normal. Most new moms feel this way at one time or another.
Here are some things you can do to ease the stress:
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If you are pregnant with more than one fetus, you can expect to have the same symptoms as those of a pregnancy with one fetus (called a singleton pregnancy). But the symptoms may happen earlier and may be worse. A multiple pregnancy is likely to cause:
Later in the pregnancy, you are more likely to have:
Most multiple pregnancies are now identified during the first or second trimester.
A fetal ultrasound can show whether there is more than one fetus in the uterus. If you have more than one fetus, you will have an ultrasound several times during the pregnancy to monitor fetal growth and amniotic fluid.
Sometimes the first sign of a multiple pregnancy is from a test that was done for another reason. For example, a very high level of human chorionic gonadotropin (hCG), the "pregnancy test" hormone, can be a sign of multiple pregnancy.
Fetuses in multiple pregnancies have an increased risk of genetic disorders and birth defects.
There are two types of birth defects tests: screening and diagnostic.
Screening tests show the chance that a baby has a certain birth defect. But they can't tell you for sure that your baby has a problem. Some of the available screening tests for birth defects are not as accurate when used for women carrying more than one baby. Talk to your doctor about your options for screening tests.
Diagnostic tests show if a baby has a certain birth defect. Diagnostic test options may include:
CVS and amniocentesis both have a slight risk of miscarriage. You may want earlier CVS results if you have to make decisions about treating or continuing a pregnancy.
For more information, see the topic Birth Defects Testing.
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.
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).
Possible pregnancy problems that can be more likely when you are carrying twins or more include:
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:
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.
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.footnote 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.
A multiple pregnancy can make morning sickness worse during the first months of pregnancy. You can treat your symptoms at home, unless you have become dehydrated or are not getting enough to eat because of vomiting.
Learn the signs of preterm labor. They may include:
Call your health professional immediately if you have symptoms of preterm labor.
Call your health professional or go to the hospital if you begin bleeding from the vagina or if your water breaks.
If you are pregnant with twins or more, it's important to:
For more information on what to expect during pregnancy, labor, and childbirth, see the topic Pregnancy.
Coping. Having a multiple pregnancy and caring for two or more infants at the same time can be overwhelming and exhausting. Lack of sleep, the increased amount of work, less personal time, and trouble maintaining the home are common sources of frustration for parents of multiple infants.
With multiple newborns to care for, it is common to feel frustrated or guilty about not managing your life as easily as before. This is normal. Get extra help for as long as possible after your babies are born. Rest as often as you can during the day. Accept help from friends and family. They can bring meals, go grocery shopping, do household chores, or care for your children while you take some time for yourself.
Some women feel sad or depressed after having twins or more. If you feel depressed for longer than 2 weeks or if you have troubling or dangerous thoughts, see your health professional. It is important that you get treatment. For more information, see the topic Postpartum Depression.
Consider joining a support group for parents of twins or more. Sharing your experience with other people who are in a similar situation may help you with the demands of caring for your babies. For more information, see the Other Places to Get Help section of this topic.
Breastfeeding? Breastfeeding more than one baby can be challenging, but it helps to build the bond between you and each baby. It gives your babies excellent health benefits. If you plan to breastfeed your babies, seek out support and information from your health professional, the hospital, or a lactation consultant before and after the birth. For more information, see Breastfeeding and Bottle-Feeding.
Parenting. Look for your new babies' personality differences and help them build their own identities over time. Give each of your children time alone with you. If you have an older child or children, schedule individual time with them too.
- American College of Obstetricians and Gynecologists (2014). Multifetal gestations: Twin, triplet, and higher-order multifetal pregnancies. ACOG Practice Bulletin No. 144. Obstetrics and Gynecology, 123(5): 1118–1132. Accessed July 8, 2014.
Other Works Consulted
- American College of Obstetricians and Gynecologists (2013). Multifetal pregnancy reduction. ACOG Committee Opinion No. 553. Obstetrics and Gynecology, 121(2): 405–410.
- Cunningham FG, et al. (2010). Multifetal gestation. In Williams Obstetrics, 23rd ed., pp. 859–889. New York: McGraw-Hill.
- Marquard K, Moley K (2012). Multiple gestations and assisted reproductive technology. In CA Gleason, SU Devaskar, eds., Avery's Diseases of the Newborn, 9th ed., pp. 60–66. Philadelphia: Saunders.
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