Pregnancy is always a happy and rewarding experience, but there are additional factors to consider when expecting twins. Learn what to anticipate and potential difficulties if you are pregnant with twins by reading on.

Conception

When sperm fertilises an egg within days after ovulation, conception occurs. A menstrual cycle usually lasts 28 days, and ovulation generally occurs midcycle, around day 14. During ovulation, a woman’s ovary generally produces one egg. There are two possible causes of twin pregnancies:

• When one or both ovaries produce more than one egg during ovulation, and each egg is fertilised and implants in the uterus, this results in fraternal twins.
• When a single fertilised egg divides into two identical embryos, this results in identical twins.

What factors increase your chances of having twins?

Twin pregnancies are more prevalent among women who:

• Are at least 35 years old
• Have a history of twins in the family
• Have a spouse who is a twin
• Have become pregnant through in vitro fertilisation (IVF)

The absence of menstruation is the first indication of pregnancy that is definite. While it may take some time to discover if you are having twins, there are a few telltale signs.

Symptoms

Women expecting twins often experience more noticeable pregnancy symptoms. Their bodies quickly adjust to support two foetuses, resulting in increased nausea, greater fatigue, and heightened breast sensitivity. Leading obstetricians state these responses are normal in twin pregnancies, indicating the body’s adaptation to the added demands. Ensuring adequate rest, a balanced diet, and regular check-ups can help manage these symptoms. If discomfort becomes unusually severe, consult your healthcare provider for personalised advice.

Gain of Weight During Twin Pregnancy

The following is the gestational weight increase for twin pregnancies:

• 37 to 54 pounds for women of average weight
• 31 to 50 kg for obese women
• 25 to 42 pounds for overweight females

To reduce the extra risks connected with having twins, it is crucial to maintain your weight as near as feasible to these standards through good food and exercise.

Initial visit to a healthcare provider

Prenatal care is crucial throughout pregnancy. If you conceive normally, your first OB appointment often occurs around the end of the first trimester. You may visit your doctor sooner if you conceive via in vitro fertilisation. Even if you have visited your healthcare provider earlier in the pregnancy, the first big checkup often occurs around the end of the first trimester (about nine to 12 weeks). This checkup may reveal that you are expecting twins. Throughout this session, your healthcare provider will review your medical history, do a physical examination and pelvic exam, and offer an overview of your care during pregnancy. Creating a list of questions to ask your healthcare practitioner can aid in their retention. Most pregnant women will also have an ultrasound of their babies to examine their heartbeats and anatomy. Your healthcare professional will do further blood tests to screen for infant genetic problems. Occasionally, you may be given a blood test to determine the gender of the foetus. Your healthcare professional will calculate the number of weeks you are pregnant and determine the due date. After the first appointment, the normal schedule for OB-GYN visits is as follows:

• Every four weeks till 28 weeks
• Every two to three weeks from 28 to 36 weeks
• Weekly from 36 weeks on
• When pregnant with twins, you may need to see your OB-GYN more often than is typical

Visits to a Perinatologist

Given that having twins is considered a high-risk pregnancy, you will likely be sent to a perinatologist (high-risk obstetrician or maternal-foetal medicine expert) to work with your OB-GYN.

Dangers and Complications

Two pregnancies are more stressful on the body than a single one. There are several hazards involved with twin pregnancies, and difficulties may arise. The following items are the most common.

Premature Labour and Delivery

In twin pregnancies, preterm labour and delivery is the most prevalent problem. Preterm birth is the delivery of a baby before 37 weeks of gestation. Twin pregnancies average 36 weeks long. Twin pregnancy and assisted reproductive technology are related to an increased risk of preterm labour and delivery. One research revealed that more than 50% of twin births were premature, compared to just 10% of single births. Preterm birth complications depend on how early the infants are born. The sooner an infant is born, the greater the danger of difficulties. Examples include:

• Immature lungs
• Respiratory stress disorder
• Apnea and bradycardia are present
• Infection
• Jaundice
• Pneumonia
• Incapability to maintain body temperature

Monitoring Placental Blood Flow with Doppler Ultrasound

Healthcare providers use Doppler ultrasound to monitor intrauterine growth restriction in twin pregnancies. This technique measures the speed and direction of blood flow in the placental and umbilical vessels. Clinicians analyze Doppler waveforms to assess vascular resistance and identify disruptions in oxygen and nutrient delivery to the fetuses. Early detection of abnormal flow patterns allows timely interventions to optimise fetal growth and reduce complications, ensuring both mother and babies receive top evidence-based care.

Preeclampsia

Preeclampsia occurs when a pregnant woman gets high blood pressure and protein in her urine. Preeclampsia is more likely to occur in twin pregnancies. It may also arise early and be more severe in repeated pregnancies.

Does Preeclampsia Disappear Following Delivery?

Preeclampsia often begins after 20 weeks of pregnancy or after delivery. Typically, this issue heals soon after delivery. Preeclampsia may cause harm to several organs, most frequently:

• Kidneys
• Liver
• Brain
• Eyes

Additionally, preeclampsia can:

• Endanger a baby’s health
• Cause placental abruption
• Result in a low birth weight

Cause premature delivery

When preeclampsia arises during pregnancy, the babies may need to be delivered early, even if they are not quite a full term, due to the associated dangers to the mother and infants. Preeclampsia symptoms include:

• Headaches
• Unclear vision
• Seeing black patches in your eyesight
• Right abdominal discomfort
• Rapid enlargement of the hands and face (edema)
• Rapid weight gain

Before pregnancy, you may reduce your risk of preeclampsia by keeping a healthy weight, exercising, and eating a balanced diet. By your healthcare provider’s advice, all of these actions become even more vital throughout pregnancy. After 12 weeks of pregnancy, the U.S. Preventive Services Task Force advises high-risk women to take 81 mg of daily low-dose aspirin to help avoid preeclampsia. Despite adopting protective steps, some women still develop preeclampsia. Women with preeclampsia, particularly those expecting twins, must be closely monitored by a medical professional due to the possibility of severe consequences.

Low foetal weight

Low birth weight is a frequent consequence of twin pregnancies since many twin pregnancies result in premature births. A newborn with low birth weight weighs less than 5 pounds and 8 ounces at delivery. Babies with a birth weight of less than 1,500 grams (3 pounds, 5 ounces) are regarded to have an extremely low birth weight. At delivery, infants weighing fewer than 1,000 grams (2 pounds, 3 ounces) are regarded to have an exceptionally low birth weight. There are two primary reasons for low birth weight: Babies delivered prematurely (before 37 weeks) are mostly responsible for low birth weight. Significant weight increase happens during the latter weeks of pregnancy; thus, premature infants lose out on the final development phases. Intrauterine growth restriction: As mentioned above, this is another disease that causes low birth weight in term infants. Complications associated with low birth weight include:

• Low quantities of oxygen during birth
• Difficulty keeping warm
• Problems with eating and weight gain
• Infection
• Problems with breathing and undeveloped lungs (infant respiratory distress syndrome)
• Problems with the nervous system, such as bleeding inside the brain
• Digestive difficulties

Sudden newborn death syndrome (SIDS)

Almost all infants with low birth weight must stay in the neonatal intensive care unit (NICU) until they gain enough weight and are healthy enough to go home.

Gestational Diabetes

Managing gestational diabetes in twin pregnancies presents unique challenges due to increased metabolic demands. Following guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), maintaining stable blood sugar levels is crucial for the health of both mother and babies.

A balanced, low-glycaemic diet is key to effective management. Women should:

• Include whole grains, lean proteins, and a variety of fruits and vegetables.
• Eat smaller, frequent meals to prevent blood glucose spikes.
• Reduce intake of refined carbohydrates and added sugars.

Regular self-monitoring of blood glucose, both fasting and after meals, allows for timely adjustments in diet or medication to keep levels within target ranges. Experts emphasize that consistent tracking supports personalised treatment plans, helping to lower risks like excessive foetal growth or preterm delivery.

Moderate physical activity, such as approved walking or swimming, complements dietary efforts by stabilising blood sugar levels. Combining regular exercise with good sleep and stress management further aids glycaemic control during a twin pregnancy.

If lifestyle and dietary changes aren’t enough to reach target blood glucose levels, healthcare providers may introduce insulin therapy or other medications under close supervision. Regular follow-up appointments, based on RANZCOG guidelines, allow for timely adjustments to treatment plans, ensuring the safety of both mother and newborns.

Placental Abruption

The placenta connects the foetus to the uterus of the mother. It is a vital source that provides nourishment and oxygen to foetuses through the umbilical cord. Placental abruption is the separation of the placenta from the uterus before delivery. The placenta usually remains connected to the uterus. Placental abruption compromises the uterus and everything that it supplies. Placental abruption is a medical emergency requiring prompt treatment since it poses a danger to the lives of both the mother and the unborn child. It may result in:

• Prematurity and inadequate birth weight
• Continual bleeding in the mother
• Death of the infant (in rare cases)

About 1 in 100 pregnancies are affected by placental abruption. This illness often occurs during the third trimester, but it may potentially occur before 20 weeks. In the third trimester of pregnancy, vaginal bleeding with discomfort is the most prevalent symptom. Occasionally, the blood will be located beneath the placenta. In this instance, no bleeding will occur. Symptoms may also include:

• Abdominal discomfort
• Uterine contractions
• Tender uterus Backache

If you experience these symptoms, you must see a healthcare professional immediately.

Twin-to-Twin Transfusion Syndrome

Twin-to-Twin Transfusion Syndrome (TTTS) is a serious complication in monochorionic pregnancies, occurring when unequal placental blood flow causes a critical imbalance between twins. This condition can deprive one twin of essential nutrients while overloading the other, increasing the risk of health issues.

Timely diagnosis using advanced ultrasound and fetal echocardiography is essential for effective management. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists highlights that early detection allows prompt intervention—often laser photocoagulation to correct abnormal vascular connections—which can markedly improve outcomes.

Effective TTTS management involves a coordinated, multidisciplinary approach, tailoring each intervention to the twins’ specific needs while minimising risks during the high-risk pregnancy.

Stage I is the mildest stage. More than three-quarters of stage I patients are stable or regressed without invasive intervention. Survival is around 86%. Advanced TTTS (stages III and above) is associated with a mortality risk of 70% to 100%, particularly when TTTS is diagnosed at or before 26 weeks. Options for treatment include:

• Amniocentesis was performed to remove extra fluid. This seems to increase placental blood flow and reduce the incidence of premature labour.
• Amniocentesis can preserve around 60% of afflicted infants.

It indicates that laser surgery may seal off the link between the blood vessels in 60% of afflicted infants. If your infants are grown enough to survive outside the womb, delivery is also possible.

C-Section

Deciding on a C-section in twin pregnancies involves assessing the twins’ positions, the mother’s health, and labour progress. If the first twin (Twin A) isn’t in a head-down (cephalic) position or Twin B is breech or transverse, a surgical delivery may be advised to reduce risks for both mother and babies. Doctors also evaluate fetal well-being, gestational age, and any underlying maternal conditions.

If both twins are properly positioned and the mother’s health is stable, vaginal delivery is a safe option. However, differences in fetal alignment or signs of distress often lead to a discussion with your obstetrician to decide the best approach. This collaborative method, following current clinical guidelines, ensures the safest delivery method is chosen.

If a C-section is recommended, healthcare providers will reduce risks by:
* Minimising infection and blood loss with careful surgical techniques
* Managing complications related to general anaesthesia
* Preventing injuries to surrounding tissues during the procedure

Working with experienced obstetric and maternal-fetal care specialists helps you understand the reasons for the recommended delivery method and ensures both maternal and fetal health are optimised.

Final Thoughts

Pregnancy might be one of the most beneficial times in a woman’s life. Maintaining a strong connection with your healthcare practitioner is essential if you expect twins to guarantee the best possible results for you and your infants.

Evan kurzyp

Evan Kurzyp

Evan is the founder of Fertility2Family and is passionate about fertility education & providing affordable products to help people in their fertility journey. Evan is a qualified Registered Nurse and has expertise in guiding & managing patients through their fertility journeys.