Multiple Pregnancy: Twins or More
Multiple Pregnancy: Twins or More
Is this topic for you?
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
What is a multiple pregnancy?
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:
- Are either all boys or all
- All have the same blood type.
- Probably will
have the same body type and the same color skin, hair, and eyes. But they won’t
always look exactly the same. They also won’t have the same
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
- Can be both boys and girls.
have different blood types.
- May look different from each other or
may look the same, as some brothers and sisters do.
See a picture of
identical and fraternal babies in the uterus.
What causes a multiple pregnancy?
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:
- You’re age 35 or older.
- You’re of
- You’ve had fraternal twins
- Anyone on your mom’s side of the family has had fraternal
- You’ve just stopped using birth control pills.
What are the risks of a multiple pregnancy?
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:
- Develop a problem that causes your blood
pressure to get too high
- Develop a type of diabetes
that can occur while you’re pregnant
- Deliver your
babies too early. When babies are born too early, their organs haven’t had a
chance to fully form. This can cause serious lung, brain, heart, and eye
- Have a
miscarriage. This means that you may lose one or more
of your babies.
- Have a baby born with a birth defect that occurs when something is wrong with the genes or chromosomes. Certain
genetic disorders may be more likely to occur in multiple pregnancies.
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
How can you tell if you’re carrying more than one baby?
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
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.
What type of treatment will you need?
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.
You’re having multiples. Now what?
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
- Go to every doctor’s
- Eat healthy foods. Take in plenty of calories from
foods rich in folic acid, iron, and calcium. These nutrients are essential for
the healthy growth of your babies. Breads, cereals, meats, milk, cheeses,
fruits, and vegetables are all good choices. If you’re not able to eat enough
because of severe
morning sickness, call your doctor.
smoke, drink alcohol, or use illegal drugs.
- Avoid using any medicines, vitamins, or herbs unless your
doctor says it’s okay.
- Talk to your doctor about what activities
are okay for you to do while you’re pregnant.
- Get a lot of
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:
- Ask your family and friends for
- Rest as often as you can.
- Join a support group
for moms with multiples. This is a great place to share your concerns and hear
how other moms cope with the demands of raising multiples.
- If you
feel sad or depressed for more than 2 weeks, call your doctor.
Frequently Asked Questions
Learning about multiple pregnancy:
Health Tools help you make wise health decisions or take action to improve your health.
Decision Points focus on key medical care decisions that are important to many health problems.
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:
- Early and excessive nausea and vomiting in the
- Extra weight
uterus that is larger than expected for your
- More fetal movement than
expected during the second trimester and later.
Later in the pregnancy, you are more likely to have:
- Varicose veins.
- Trouble breathing (caused by pressure on the lungs
from the uterus pushing up on the diaphragm).
- Indigestion (caused by pressure on the stomach from
the large uterus).
- A very large belly
- Gestational diabetes.
- Preeclampsia, a serious disorder of circulation and
blood pressure that affects both mother and fetuses.
- Preterm labor.
Exams and Tests
multiple pregnancies are now identified during the
first or second
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
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.
Tests used during a multiple pregnancy
- Blood pressure checks at every
prenatal appointment are used to monitor you for high blood pressure or
- Blood testing is used to
check you for low iron (anemia). Anemia is a common problem for
women with multiple pregnancy, because the fetuses use a great amount of the
mother’s iron stores.
urine test and
urine culture can be used to screen you for a
urinary tract infection (UTI).
- Transvaginal ultrasound may be used to check the
length of your cervix. A short cervix is a sign of an increased risk of
- In the second trimester,
you may have an
oral glucose screen to check for
- Electronic fetal heart monitoring may be used before
or during delivery, to make sure the fetuses are doing well.
Tests used to check for birth defects
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:
- Chorionic villus sampling (CVS). It uses a tiny piece
placenta, taken by passing a thin tube through your
vagina and cervix and into the uterus. It can also be done through the abdomen with a needle. The sampling and genetic testing are
done between 10 and 13 weeks of pregnancy.
- Amniocentesis, which uses a small amount of amniotic
fluid, taken by inserting a needle into your abdomen and uterus. The sampling
and genetic testing are usually done between 15 and 20 weeks of pregnancy.
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.
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.
Prenatal care during a multiple pregnancy
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).
Watch for problems
Possible pregnancy problems that can be more likely when you are carrying twins or more include:
- Preeclampsia and high blood pressure. Treatment
depends on how severe your condition becomes. It may include medicine, bed
rest, fetal monitoring, and early delivery. For more information, see the topic
Preeclampsia and High Blood Pressure During Pregnancy.
- Problems with the placenta, such as
placenta abruptio or
placenta previa. For more information, see
Placenta Abruptio and
- Anemia, which
is treated with iron-rich foods and iron supplements. If this doesn’t help, you
can be tested for other problems that can cause anemia.
- Too much
amniotic fluid in the uterus (polyhydramnios). Treatment can include
medicine and removal of amniotic fluid.
- Urinary tract infection (UTI), which is treated with antibiotics.
- Heavy blood loss
after delivery (postpartum
hemorrhage), which can require a blood
- The need to deliver by
cesarean section (C-section). You will likely need a C-section if your babies (fetuses) are not turned head-down
in time for birth (breech or transverse fetus).
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:
- Limiting your activity level.
- Staying in the hospital. This is often so that you can receive
steroid medicine to help your babies’ lungs develop faster. In some cases,
tocolytic medicine is used in an attempt to delay
preterm birth. You are closely watched if you are treated with a tocolytic
For more information, see the
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.
Early pregnancy decisions about triplets or more
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
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
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
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:
- Cramping similar to menstrual
- Abdominal cramps, possibly with
- Contractions of your uterus that don’t go away, about 6 or more in 1 hour.
- Pressure in your lower back, especially if it comes and
- An increase in your usual amount of vaginal discharge.
Call your health professional immediately if you have symptoms of preterm labor.
health professional or go to the hospital if you begin bleeding from the vagina
or if your water breaks.
Self-care for multiple pregnancy
If you are
pregnant with twins or more, it’s important to:
- Get enough nutritious calories, folic acid, iron, and calcium to nourish you and
your babies (fetuses).
things that could hurt your babies, such as:
- Reduce your physical activity. Most doctors will
recommend that you stop physically demanding exercise after 24 weeks of a
multiple pregnancy. Talk to your doctor about walking or
- Get plenty of rest, especially after the 24th week of
- Consider whether you need
to change your daily work activities, based on how well your pregnancy is
going. Be sure to follow any advice to reduce your activity
- See your health professional often. Beginning in the 20th
week of pregnancy, you may be checked every other week. Beginning at the 30th
week, you may be checked more often.
For more information on what to expect during pregnancy,
labor, and childbirth, see the topic
After the babies are born
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.
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
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
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.
Other Places To Get Help
- 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.
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Adam Husney, MD – Family Medicine
Elizabeth T. Russo, MD – Internal Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer William Gilbert, MD – Maternal and Fetal Medicine
Current as ofJune 8, 2017
Current as of:
June 8, 2017