Multiple Births

In the last decade, the number of twin births has risen by 31% and the number of triplets, quadruplets or greater jumped by 245%. Most multiple pregnancies are created in the process of overcoming infertility. Assisted reproductive techniques account for more than 95% of these pregnancies.

Thanks to advances in the care of women with multiple fetuses, most births are healthy, but success requires careful monitoring of the mother’s health.

Ensuring a Healthy Pregnancy
Early detection of problems is key to the health of mother and babies. With a multiple pregnancy, ultrasound testing is used to monitor the growth and development of each fetus. Other tests, such as amniocentesis and chorionic villi sampling (CVS) are used to determine any genetic abnormalities or special needs of the babies, which are more common in multiple gestation. Measures geared toward preventing premature birth include frequent prenatal visits, monitoring the cervix through ultrasound and assessing uterine contractions.

While multiple fetuses, especially in women over age 35, bring increased risk for gestational diabetes and pregnancy-induced hypertension, these conditions can usually be managed without complications. Expectant moms of multiples, however, must make more frequent visits to the obstetrician. Mothers who are pregnant with multiples must be particularly careful about their diets. Each fetus requires about 300 calories per day which results in about 10 pounds above the average weight gain during pregnancy. Certain nutrients, such as calcium and iron, must be consumed daily, and doctors often prescribe supplements to ensure the right dosage. Too much weight gain can be dangerous, however, especially in women at risk for toxemia. The key is eating a balance of healthy foods and keeping track of the special nutritional requirements of pregnancy.

Lifestyle Issues
Depending on the type of work they do, most women with single fetus pregnancy can continue right up to the day of delivery. Mothers of multiples, however, must be carefully monitored for early labor, and often have to restrict their activities and increase their bedrest. Arrangements for maternity leave and child care should be made early in the pregnancy since a mother of multiples is more likely to have to leave work weeks or months before her actual due date.

The excitement and anticipation of pregnancy can also bring added stress, especially in parents who have experienced infertility and miscarriage. Hormonal shifts, other physical changes of pregnancy, and the ordinary pressures and demands of becoming a parent can cause depression and irritability. The successful adjustment of any couple depends on their willingness to communicate, learn from each other, and seek help from support groups or a professional counselor, when necessary. Parents of multiples have created newsletters, clubs, web sites and other resources to help each other.

Though it may seem like an eternity, pregnancy is a brief moment in a mother’s life, and the real work comes after the babies are born. The chaotic first weeks will eventually settle into a more natural rhythm.

Editorial provided by Jack Ludmir, MD, Chairman, Department of Obstetrics and Gynecology, Pennsylvania Hospital, in Philadelphia, Pennsylvania.