|
Multiple
Pregnancy
If you are pregnant
with twins, triplets or more, you have a multiple pregnancy. Multiple
pregnancies are considered "high risk". This means the odds that
either you or one of your babies might have pregnancy related problems
is increased compared to a woman carrying only one fetus. This doesn't
mean you will have
problems. Many women have successful, uncomplicated twin pregnancies.
But, pregnancy involves some risk for every woman, and with each
additional fetus the risks increase.
About
Multiple Births
The chance of having a multiple birth depends on many factors. Multiple
pregnancy can occur when one egg (ovum) splits before implanting.
Identical twins or triplets occur with the fertilization of a single
egg that later divides into two or three identical embryos. Identical
twins or triplets have the same genetic identity, are always
the same sex, and look almost exactly the same.
Fraternal
multiples develop from separate eggs which are fertilized by different
sperm. This can occur when the mother produces more than one ovum
during ovulation. You have a higher chance of this happening if
you are older, taller and heavier, if you are a twin yourself, or
if having twins runs in the maternal side of your family. The use
of drugs that increase fertility, such as Clomid and Pergonal, increases
your chance of multiple birth.
Infertility
procedures like in vitro fertilization (IVF), gamete intrafallopian
transfer (GIFT), and zygote intrafallopian transfer (ZIFT), increase
the chance of a multiple gestation. These procedures often involve
the transfer of more than one fertilized eggs into the mother's
womb to increase the odds of pregnancy occurring.
In
a pregnancy with triplets or more, the babies can be all identical,
all fraternal, or a mixture of both. This can happen when multiple
eggs are released by the mother and fertilized. If one or more of
these fertilized eggs divides into two or more embryos, a mixture
of identical and fraternal multiples will occur.
What
are the Risks?
As a rule and when available, women having multiple pregnancies
are often referred to a Perinatologist, or Maternal-Fetal Medicine
(MFM) Specialist. This type of physician is an obstetrician with
advanced training in high risk pregnancy care. MFM Specialists complement
the care of general obstetricians by providing prenatal care for
high-risk women. They are experienced at caring for the special
needs of women having a multiple birth.
|
Increased
Risks Of Multiple Pregnancy
|
| Severe
Nausea and Vomiting |
Early
in your multiple pregnancy you may experience all the discomforts
a woman with a singleton pregnancy feels. Nausea, vomiting,
fatigue and breast tenderness are more likely to be severe
in multiple pregnancy. Sometimes a condition called "hyperemesis
gravidarum" can occur. This is a condition where nausea and
vomiting become so severe that dehydration can occur.
If
you are experiencing a lot of vomiting or are unable consume
liquids, you should call your provider. You may need intravenous
fluid replacement and medication to reduce the vomiting. If
you notice a decrease in the frequency of when you urinate,
or if you notice that your urine is dark in color, you should
call your provider. These can be signs of dehydration.
|
| Preterm
Delivery |
One
of the biggest risks of carrying twins or more is that you
will deliver your babies early. Premature delivery occurs
when you deliver your babies before the thirty-seventh week
of gestation. Twin pregnancies have about a 30 percent chance
of a premature delivery. The risk increases for triplets and
if you are expecting quadruplets or more you can be fairly
certain you will deliver early.
Early
delivery can occur for a number of different reasons. Preterm
labor is common in multiple pregnancy and is a leading
cause of preterm delivery. Preterm labor occurs when uterine
contractions become too frequent or intense enough to cause
cervical shortening (effacement ) or opening (dilation) prior
to week thirty - seven of your pregnancy.
If
one or more of your babies appears to be small or have a growth
rate that is declining, (intrauterine growth retardation or
IUGR), early delivery could be indicated. Multiple pregnancies
carry a higher risk of IUGR than singleton pregnancies.
|
| Twin-to-Twin
Transfusion |
Twin
to twin transfusion syndrome is a disease of the placenta.
There are connections between the blood vessels of the babies.
This can cause an overload of blood in one baby, the recipient,
while the donor baby does not get a sufficient blood supply.
When the condition is severe, it can result in one large
baby with excess amniotic fluid (polyhydramnios) and one
small baby with too little amniotic fluid (oligohydramnios).
The smaller baby is referred to as a "stuck" twin.
Twins that develop from one egg (identical) can share
some blood vessels. This can lead to a pregnancy complication
called twin-to-twin transfusion syndrome(TTTS). Your babies'
risk of developing this syndrome is determined in part by
when the egg divides.
Eggs
that divide within a few days of ovulation are known as
diamniotic-dichorionic (Di-Di). The amnion and chorion are
the two layers of the sac of fluid that surrounds and protects
babies in your uterus. DI-DI means that each baby has its
own amnion and its own chorion.. These twins do not develop
twin-to-twin transfusion.
Eggs
that split at about three to eight days after ovulation
create twins that are diamnionic (each has it's own amnion)
and monochorionic ( they share a single chorion). These
identical twins share some placental vessels and have the
highest risk of TTTS.
|
| Discordant
Growth |
If one of
your babies isn't growing as fast as the other(s), your doctor
may become concerned about the smaller baby's health. This discordant
growth can occur for several reasons. One baby may have a placenta
that implants in an area with a less abundant blood supply.
|
| Pregnancy
Induced Hypertension |
PIH is the
same as preeclampsia-eclampsia. PIH usually occurs in the second
half of pregnancy. It is characterized by increased blood pressure
and protein in the urine. Hands and feet may become swollen.
Women expecting twins or more develop pregnancy induced hypertension
(PIH) more frequently. The risk increases with the more babies
you are carrying. |
Nutrition Tips for Twins and More
Weight
Gain
Women expecting two or more babies should have a higher
weight gain. If you are expecting twins, a net weight gain at
term of about 35 - 45 pounds (16 to 20.5 kilograms) is recommended.
If you started your pregnancy underweight, a little more weight gain
is desirable. Women starting pregnancy at a heavier weight should
gain a little less. Studies have shown that adequate second and third
trimester weight gain is very important with twin pregnancies. Weekly
weight increases of about 1.5 pounds per week (0.6 kilograms) are
desirable at this time and weight loss should be avoided.
If
you are expecting triplets or more, your weight gain should be even
higher. There isn't enough information about these higher multiple
pregnancies to give specific weight targets. Most weight gain goals
for pregnant women are calculated based on a full term pregnancy
(37 weeks gestation or more) and you are likely to deliver your
babies before this if you are expecting three or more. Aim for a
weight gain of 1.75 - 2.0 pounds (0.8 kilograms) or more per week
in your second and third trimester. Discuss your weight gain with
your provider at each prenatal visit.
|
Tips
To Improve Weight Gain
|
- Eat
often
Growing babies mean less room for your stomach to expand.
Eating more often can compensate for smaller meals.
- Drink in some calories
Water takes up the same amount of room in your stomach as
fruit juice or milk. Fruit smoothies and milkshakes are
great sources of calories.
- Choose
high fiber foods
Preventing constipation can help your appetite. Fruits,
vegetables, whole grains, beans and bran cereals are good
high fiber choices.
- Choose
nutrient dense snacks
Peanut butter, nuts, cheese, dried fruit, granola and yogurt
are a few.
|
Supplements
A prenatal vitamin is usually recommended with the increased
nutrient needs of a multiple pregnancy. Be sure and take only one
prenatal pill as multiple pregnancy does not double the need for
supplementation and some vitamins or minerals can be harmful if
taken in excessive amounts.
Vitamin
and mineral supplements cannot replace a healthy diet. Protein,
fluid, carbohydrate, fat and fiber are found in the foods and beverages
you consume. Take only the supplements you have been prescribed,
and rely on a healthy diet to meet most of your nutrition needs.
Your
provider may prescribe additional iron or folate supplements if
your lab results indicate you are anemic. Iron and folate are nutrients
that support the expanding blood volume that occurs in all pregnancies.
Calcium
rich foods and calcium supplements decrease iron absorption. Take
your prenatal vitamin and iron with juice or water. Take any calcium
supplements at another time of the day.
Choosing
Healthy Foods
The food guide below can help you select the minimum number
of servings from important food groups to ensure a healthy diet.
Because calories are not addressed in this guide, you will need
to consume extra foods from each category daily. Women expecting
triplets will require even more. All pregnant women should keep
themselves well hydrated. Consume 8-10 cups or more of liquids every
day. You should be urinating regularly and your urine should be
pale in color when your fluid intake is sufficient.
|
Daily
Food Guide for Twin Pregnancy
|
Food Group
|
Serving
Size |
Suggested
Servings Each Day |
| Protein |
2
eggs,cooked
3 oz cooked portion meat, fish or chicken
1 cup cooked beans
6 oz tofu
4 tbsp. Peanut butter |
3
- 4 |
| Milk
and Calcium-Rich Foods |
1
cup milk or yogurt
1 cup pudding or custard
11/2 oz hard cheese
1 cup fortified soy beverage
4 tbsp. Parmesan cheese
11/2 cup ice cream
8 oz calcium fortified orange juice |
4
|
| Vitamin
C Rich Fruits and Vegetables |
6
oz orange or grapefruit juices
1 orange, kiwi or mango
1/2 grapefruit or cantaloupe
1/2 bell pepper |
1-2
or more |
| Beta
Carotene Rich Fruits and Vegetables |
6
oz apricot nectar
3 raw or 1/4 cup dried apricots
1 carrot
1/2 cup yams
1/2 cup winter squash (butternut,hubbard, acorn) |
1
or more |
| Additional
Fruits and Vegetables |
6
oz fruit or vegetable juice
1 small piece fresh fruit
1 cup raw vegetables
1/2 cup cooked vegetable
1/2 cup canned fruit |
3
or more |
| Unsaturated
Fats |
1/8
avocado
1 tsp. vegetable oil (canola & olive are good choices)
1 tsp. mayonnaise
1 tbs. sunflower seeds
2 tbs. nuts
1 tsp. margarine |
2-4 |
Staying
Healthy
Enrolling in prenatal care early and keeping all your appointments
is of paramount importance. With a multiple pregnancy you will see
your health care provider more frequently. You may also have additional
appointments for tests such as ultrasounds,
additional lab work, and specialist doctors. You may need to
be evaluated by a registered dietitian to ensure your weight gain
and nutrient intake is adequate.
All
the precautions for a singleton pregnancy are even more important
when your pregnancy is high risk. Avoid exposure to cigarettes and
don't use alcohol or illegal substances. Check with your care provider
before using any prescription drugs or over-the-counter medications.
Ask about any restrictions on your physical activity. Avoid heavy
lifting and discuss any concerns about your work or home environment
with your provider.
Bedrest
Your provider may prescribe some bedrest
or limited activity at some point in your pregnancy. Bedrest is
a strategy employed to try and prevent preterm
delivery. Medications to stop preterm labor may be used
in conjunction with bedrest. It is important that you follow your
provider's recommendations for bedrest and take any medication prescribed
on schedule.
Avoid
laying on your back while resting. The weight of your pregnant abdomen
can compress the blood vessels supplying your babies. Laying on
your left side increases the blood flow to your heart, uterus and
babies.
Put
an egg-crate type foam pad on your bed to help with the discomfort
of laying down for long periods. Keep reading materials, snacks
and water near you. This is a good time to start a pregnancy journal.
Getting
Help
Caring for more than one newborn is daunting to say the least!
Start lining up help as soon as you know you have a multiple pregnancy.
If you end up on bedrest you will need help even before you deliver.
Friends and family can help with baby care, housecleaning, food
preparation and shopping. If you already have children, you may
need some extra baby-sitting.
Most
communities have local "Mother's of Twins" organizations. Hooking
up with these groups early in your pregnancy is a great way to establish
some contacts with experienced moms of multiples who can be a valuable
source of practical information.
|
