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Twin Pregnancy FAQs: The Likelihood, The Risks, and Expert Tips

Blog

Twin Pregnancy FAQs: The Likelihood, The Risks, and Expert Tips

Dr. Giles and new mom Chloe share insights and advice

Becoming pregnant with twins is a double blessing for sure; but carrying and giving birth to two little miracles at a time comes with added challenges. We talked with Dr. Allison Giles and her patient Chloe Birk, who just became a mom of twin boys in January, about what to expect when you’re expecting twins. Here are their answers to some frequently asked twin questions and tips for twin moms and moms-to-be.

How likely is it that I will become pregnant with twins?

Dr. Giles: Roughly 3% of live births in the United States are twins. Twin pregnancies are more common for patients who are of “advanced maternal age” (one of my least favorite terms!), which means 35 or older at time of delivery. Twins are also more common in patients who undergo fertility treatments. And since pregnancy at later ages and fertility treatments are more common these days, twin pregnancies are also becoming more common.

Maternal family history does increase the chance of conceiving twins! If twins run in the father’s side of the family, that does not increase his chance of fathering twins, but it does increase the chance of passing the “twin gene” on to his daughter(s). Fraternal twins are the type of twins that run in the family, while identical twins are not genetic.

Interestingly, tall women (over 5’5”) and obese women (BMI >30) have a greater chance of conceiving twins

What risks come with twin pregnancy?

Dr. Giles: Twin pregnancies are considered higher risk than singleton pregnancies (pregnancies with only one baby).  Some of these risks include having small babies (also called growth-restricted babies), babies with congenital anomalies, preterm delivery, and preeclampsia (a complication marked by high blood pressure in the mother). One of the most significant risks is preterm delivery because babies who are born prematurely are at increased risk for complications after they are born.

There are different types of twin pregnancies. A dichorionic/diamniotic pregnancy is the most common and least risky. These babies are usually fraternal, they each have their own placentas and amniotic sacs. The next type is called monochorionic/diamniotic twin gestation. This is a riskier type of twin gestation where identical twins share one placenta but have their own amniotic sacs to separate them. The babies can share circulation, which can lead to a complication called twin-to-twin transfusion syndrome. The highest risk twin gestation is called monochorionic/monoamniotic, where identical twins share a placenta and an amniotic sac. In addition to the possibility of developing twin-to-twin transfusion syndrome, these babies are at high risk for cord entanglement.

Woman smiling lying down with twin babies
Chloe Birk and her twin baby boys

How do I manage these additional risks without getting overwhelmed?

Chloe: Having an OB/GYN you trust is key. Find a doctor you feel very comfortable with because you’ll have a ton of questions. Dr. Giles was always very patient and kind throughout my pregnancy. She was able to calm my fears by keeping me well-informed, explaining things in great depth so that I understood completely before moving on to the next question. She treated me as a friend. Twins can be scarier than a singleton pregnancy, and to have a doctor who will be patient, talk to you and be a friend to you – that’s exactly what you need during a high-risk pregnancy.

How will my prenatal care be different if I’m pregnant with twins?

Dr. Giles: Twin pregnancies require increased surveillance compared to singleton pregnancies. Patients who are pregnant with twins are generally seen at more frequent intervals. Many of these visits will include an ultrasound to make sure the babies are growing normally. Sometimes, the care will be shared between the patients’ general OB/GYN and a high-risk pregnancy specialist called a perinatologist.  Together, they work to ensure a safe and healthy pregnancy with the best outcomes for mom and babies.

It is also recommended that, starting at 12 weeks, all women pregnant with twins begin taking a daily low-dose aspirin to help prevent preeclampsia.

What should I do in terms of self-care if pregnant with twins?  Will I need to eat more?

Dr. Giles: Generally speaking, maintaining an active lifestyle that includes moderate exercise is healthy and encouraged throughout a twin pregnancy. That usually means that moderate aerobic exercise, combined with plenty of stretching and rest, is safe.

Since growing twins requires more energy, more caloric intake is required – my favorite! The goal is to eat around 600 more calories per day than usual. Of course, these extra calories should come from lean proteins, vegetables, and fruit. Moms that start the pregnancy at a normal weight are recommended to gain 37-54 pounds. Those who are overweight to start should aim to gain between 25 and 50 pounds.

Chloe: Be careful about what you are eating: make sure that you’re eating enough and that it’s a high protein diet. And drink plenty of water!

How are twins delivered?

Dr. Giles: Even the most uncomplicated twin pregnancies are delivered prior to the due date at 38 weeks. If complications should arise, such as growth restriction, preeclampsia, or preterm rupture of membranes, earlier delivery may be indicated.

It is always our hope to deliver twins vaginally; however, that is not always possible and is highly dependent on the twins’ positions inside the uterus and their individual sizes. For instance, if the presenting twin is breech (feet down), it is recommended that a c-section be performed for safe delivery. If the presenting twin is vertex (head-down), vaginal delivery is preferred if feasible. Sometimes, the first twin is delivered vaginally but the second needs to be delivered by c-section. For this reason, most twin deliveries take place in the operating room – to facilitate a quick pivot to cesarean section for twin B if required.

What are some helpful resources for twin moms and moms-to-be?

Dr. Giles: Some of the best resources are your physicians! Both your OB/GYN and your pediatrician have expert knowledge about these wonderful pregnancies and babies. For help with building your registry, understanding and recognizing pregnancy symptoms, and a general overview about what to expect with multiples, I recommend lucieslist.com/ages-stages/twins/.

How about resources for nursing twin babies?

Dr. Giles: The local hospitals all have excellent resources when it comes to immediate postpartum lactation support, should you choose to breastfeed. Once discharged after delivery, there are plenty of lactation resources within the Richmond community, some of which are listed on richmondmom.com/breastfeeding-resources/. Finding other twin moms can also be a great source of knowledge and comfort.

Chloe: Drinking lots of water helps with nursing, too. So does having a great support system. Make sure your partner is on board with whatever vision you have. When you feel overwhelmed, they can support you and remind you of your personal vision. Also, find a great lactation consultant. He or she will help you do what you can’t figure out on your own.

Any last tips?

Chloe: Figure out how to sleep when the babies sleep, and don’t sweat the small stuff!