If you are expecting twins and don't know what to expect,
you are not alone. Many women pregnant with twins have no idea what to expect,
but that doesn't mean they -- and you -- can't learn. So here is some
information to help you understand what's happening when you're expecting
twins.
A twin pregnancy is a double blessing, but it can
also carry greater risks than singleton pregnancies.
In the U.S, about three in every 100 pregnant women give
birth to twins or triplets, according to the Mayo Clinic in Rochester, Minn.
And by many accounts, twin pregnancies are on the rise.
Be prepared. Familiarize yourself with the top 11 things
you didn't know about your twin pregnancy from conception through
delivery.
No. 1: You are more likely to become
pregnant with twins naturally when you are in your 30s and 40s.
We all hear that the older we get, the harder it is to
conceive, but advancing age may actually increase the likelihood of a twin
pregnancy, says Abdulla Al-Khan, MD, the director and chief of maternal and
fetal medicine and surgery at Hackensack University Medical Center in New
Jersey. "Once you are 25 or into your 30s and 40s, ovulatory cycles are
not regular anymore. If you are not regular and do ovulate, you could be ovulating two follicles at the same time."
Voila! A twin pregnancy -- without assisted reproductive technologies.
Women pregnant with twins may need more folic acid to
help stave off birth defects, says
Manju Monga, MD, the Berel Held Professor and the division director of
maternal-fetal medicine at the University of Texas Health Sciences Center in
Houston.
"We recommend 1 milligram of folic acid per day for
twin pregnancies and 0.4 milligrams for singleton pregnancies," says
Monga, who has twins. Folic acid is known to reduce risk of neural tube birth
defects such as spina bifida.
Twin pregnancies require more monitoring than single
pregnancies, Monga says. "We tend to do more frequent ultrasounds for
growth in twin pregnancies, compared with one anatomy scan and one growth scan
in a singleton pregnancy."
But along with additional testing comes risk. For example,
the chance of miscarriage after amniocentesis is higher in
twin pregnancies, Al-Khan says. "You are sticking the mother twice, so if
the risk of miscarriage is one of 1,000 in singleton pregnancies, it would
increase it to one in 500 for twins."
No. 4: Morning sickness may be worse with twin pregnancies.
"One of the things that is postulated as causing morning
sickness is high levels of human chorionic gonadotropin, and we know
that levels of this hormone are higher in twin pregnancies, so women carrying
twins have a higher incidence of nausea and vomiting in the first
trimester," says Al-Khan. The good news? Most morning sickness abates within 12 to 14 weeks of pregnancy
-- even in twin pregnancies.
That's not all, Monga says. Moms pregnant with twins
complain of more back pain, sleeping difficulties, and heartburn than
moms who are carrying one child. Moms pregnant with twins also have a higher
rate of maternal anemia and a higher rate of postpartum hemorrhage
(bleeding) after delivery.
No. 5: Spotting may be more common during twin pregnancies.
"When you spot in the first trimester, you could be
undergoing a miscarriage, and miscarriages are more common in mothers of twins,
triplets, and quadruplets -- so we see more spotting in first trimester with
multiples," Al-Khan says.
But a little spotting is no reason to hit the panic button
even in twin pregnancies. "A little spotting in the absence of cramps is
reassuring, but when you are cramping, passing clots, and actively bleeding,
that is a sign that's something is happening and you should seek medical
advice."
No. 6: You don't feel the babies kicking any earlier with
twin pregnancies.
"Generally when you are pregnant with twins, fetal
movements become more noticeable at weeks 18 through 20 of pregnancy, and the
same is true in singleton pregnancies," Al-Khan says. When a woman begins
to feel fetal movements actually depends on whether she has been pregnant
before. "If you have been pregnant before, you know what fetal
movement is, but if you are pregnant for the first time, you really can't
distinguish the movement from gastrointestinal activity."
No. 7: Moms pregnant with twins may gain more weight than
moms carrying one child.
"With twins, mothers gain more weight as there are two
babies, two placentas, and more amniotic fluid," says Al-Khan.
"You also need more calories for twin pregnancies."
Still, there is not a well-established formula for weight
gain during twin pregnancies, says Monga. "The average weight gain
is 25 pounds for singleton pregnancy and 30-35 pounds for twins. We don't want
moms pregnant with twins to gain more than 40 [pounds] or less than 15
pounds."
The Institute of Medicine's provisional guidelines for weight
gain in women expecting twins say:
Women of normal weight should aim to gain 37-54 pounds
Overweight women should aim to gain 31-50 pounds
Obese women should aim to gain 25-42 pounds
Exactly how much weight should you gain? The IOM recommends
that you talk to your health care provider about that, because every
pregnancy is unique.
No. 8: Risk of developing gestational diabetes is higher in
twin pregnancies.
"The gestational diabetes risk is higher in
twin pregnancy," says Monga. That said, the biggest risk of gestational
diabetes is having larger babies and requiring a C-section delivery, she says.
"While gestational diabetes is more common, the
morbidity associated with it is less common because twin babies are not big
babies."
Still, moms who develop gestational diabetes during
pregnancy are more likely to develop type 2 diabetes later in
life, she says.
No. 9: Risk of preeclampsia during pregnancy is higher in
twin pregnancies.
"People really don't know what causes preeclampsia to start, but we know it occurs more
frequently in twin pregnancies," Monga says. Preeclampsia is marked by high
blood pressure, protein in the urine, and sometimes swelling in the feet, legs,
and hands. It is the precursor to the more serious, potentially fatal
eclampsia.
Most moms carrying twins go into labor at 36 to 37 weeks,
as opposed to 40 in a single pregnancy, Al-Khan says, and some may go even
earlier. "Generally, if the twins are born after 34 weeks, there should
not be a major concern, but a premature baby is still a premature
baby," he says. "Twins are at higher risk of preterm labor and
delivery and have higher degree of respiratory issues." As a result
of being born too early, twins may be born at low birth weights, and such
babies tend to have more health problems than babies born weighing more than
5.5 pounds.
Unfortunately, there is no evidence that bed rest alone
prevents preterm labor or delivery in twin pregnancies, and the use of agents
to stop preterm labor have not been proven to be effective either, he says.
"Stopping premature labor is challenging in multiple
gestations."
No. 11: Cesarean section deliveries may be more common in
twin pregnancies.
"The likelihood of having a C-section is absolutely
higher in twin pregnancies," he says. "There is also a higher
incidence of the baby being in breech position among twins than
singletons." When the baby is in a breech position, a C-section delivery
is usually required.
http://www.webmd.com