Pregnant with Twins: What to Know When Expecting

Embarking on the journey of a twin pregnancy brings both excitement and consideration for expectant parents. Let’s delve into the world of twin pregnancies, exploring its intricacies and potential risks that mothers might encounter on this unique journey, and providing insights to make it as smooth as possible for new parents.

What is a twin pregnancy?

A twin pregnancy occurs when a woman is expecting two babies at the same time.

How does a twin pregnancy occur?

Twin pregnancies typically happen in two ways:

• Identical (monozygotic): Identical twins develop when a single fertilised egg splits into two embryos. These twins look very similar because they share the same genetic material.
• Fraternal (dizygotic): Fraternal twins result from the fertilisation of two separate eggs by two different sperm. Fraternal twins are more like regular siblings who just happen to be born at the same time.

What are the factors that could increase the chances of conceiving twins?

The likelihood of conceiving twins is influenced by both genetic and environmental factors. Here are some factors that can increase the chances of having twins:

• Family history: If there are twins in your family, especially on the mother's side, the likelihood of having twins may be higher. This is because certain genetic factors can increase the chances of hyperovulation (releasing more than one egg during ovulation).
• Age of the mother: Women over the age of 30, and particularly those in their 30s and early 40s, are more likely to release more than one egg during ovulation. This increases the chances of fraternal twins.
• Assisted reproductive technologies (ART): Fertility treatments, such as In-vitro Fertilisation (IVF) and ovulation-stimulating medications, can increase the chances of having twins. This is because these treatments often involve the release of multiple eggs.
• Number of previous pregnancies: Women who have had multiple pregnancies are more likely to conceive twins. This may be due to changes in the ovaries or hormonal factors that can occur with multiple pregnancies.
• Number of children: Women who have already given birth to one set of fraternal twins have a higher chance of having another set.

It's important to note that the factors influencing the likelihood of conceiving twins are complex, and having one or more of these factors does not guarantee the conception of twins.

What are the potential signs and symptoms that may indicate a twin pregnancy?

While each pregnancy is unique, certain signs and symptoms may indicate a twin pregnancy. However, medical examinations, including ultrasound imaging, are the most reliable way to confirm it. Signs may include:

• Early and intense pregnancy symptoms: Some women carrying twins may experience more pronounced pregnancy symptoms, such as morning sickness, fatigue, and breast tenderness, due to higher levels of hormones associated with a multiple pregnancy.
• Rapid weight gain and larger abdominal size: Women expecting twins often gain weight more quickly and may have a larger abdominal size compared to those with a singleton pregnancy. This can be noticeable in the early stages of pregnancy.
• Measuring large for gestational age: During prenatal check-ups, healthcare providers measure the size of the uterus. If a woman is consistently measuring larger than expected for her gestational age, it might be an indicator of a multiple pregnancy.
• Increased foetal movement: Some women carrying twins report feeling more foetal movement than those with a singleton pregnancy. This is because each baby may have less space in the uterus, leading to more noticeable movements.
• Higher human chorionic gonadotrophin (hCG) levels: Elevated levels of the pregnancy hormone hCG may be detected in the blood or urine, suggesting a twin pregnancy. However, hCG levels can vary widely among individuals, so this is not a definitive indicator.

If you suspect a twin pregnancy, it's advisable to consult with a healthcare professional for proper evaluation and guidance.

What challenges do mothers face when carrying multiples?

Expecting twins brings about various considerations, especially when it comes to the type of twins involved. These can significantly impact the pregnancy and potential complications.

• Dichorionic diamniotic (DCDA) twins, which are considered the "best" scenario in terms of complications, are relatively common, occurring in about 1 in 250 pregnancies. Each twin has its own chorionic and amniotic sac, reducing the risk of complications related to sharing these structures.
• Monochorionic diamniotic (MCDA) twins, while less common than DCDA twins, still occur with some frequency. They share a chorionic sac but have separate amniotic sacs. This shared placenta can lead to a specific complication known as twin-to-twin transfusion syndrome (TTTS), where there's an uneven blood flow between the twins, potentially endangering both.
• Monochorionic monoamniotic (MCMA) twins are even rarer, occurring in only about 1 in 10,000 pregnancies. In this case, both the chorionic and amniotic sacs are shared, increasing the risk of complications such as umbilical cord entanglement and affecting blood flow, potentially causing developmental issues.
• Conjoint twins represent an exceptionally rare and highly complex scenario. They are physically connected due to incomplete separation of the embryos, necessitating intricate medical interventions and presenting significant challenges for both the pregnancy and delivery process.

These various types of twins highlight the diverse range of challenges mothers may face when carrying multiples. In addition to the generic risks associated with twin pregnancies, such as miscarriage, premature labour, low birth weight, gestational diabetes, and high blood pressure, the specific complications associated with each type of twin add layers of complexity.

While the journey may seem daunting, there are several ways mums can navigate the challenges of a twin pregnancy.

• Regular Prenatal Care:
  • Schedule regular prenatal check-ups with your healthcare provider.
  • Follow the recommended schedule for ultrasounds and other prenatal tests to monitor the growth and development of both babies.
• Healthy Diet:
  • Consume a well-balanced and nutritious diet that includes a variety of fruits, vegetables, whole grains, lean proteins, and dairy products.
  • Stay hydrated by drinking plenty of water.
• Adequate Weight Gain:
  • Gain the recommended amount of weight as advised by your healthcare provider. Proper weight gain is crucial for the health of both you and your babies.
• Rest and Relaxation:
  • Get enough rest and sleep to support your body's increased demands during pregnancy.
  • Avoid excessive physical exertion and consider modifying your daily activities as needed.
• Avoid Smoking and Alcohol:
  • Quit smoking and avoid alcohol, as they can pose serious risks to the health of your babies.
• Stay Active:
  • Engage in low-impact exercises that are approved by your healthcare provider, such as walking or swimming, to promote circulation and overall health.
• Monitor Blood Pressure:
  • Keep an eye on your blood pressure. High blood pressure can lead to complications, so report any changes to your healthcare provider.
• Gestational Diabetes Screening:
  • Undergo screening for gestational diabetes as recommended by your healthcare provider.
• Manage Stress:
  • Practice stress-reducing techniques such as deep breathing, meditation, or prenatal yoga to promote emotional well-being.
• Educate Yourself:
  • Learn about the signs and symptoms of preterm labour and other complications so that you can promptly seek medical attention if needed.
• Cervical Length Monitoring:
  • In some cases, healthcare providers may monitor cervical length to assess the risk of preterm labour.

Always consult with your healthcare provider for personalised advice based on your specific health condition and the unique aspects of your pregnancy.

Twin pregnancies often involve more frequent monitoring and care to ensure the best outcomes for both mother and babies.

It is important to have early scans for twins, ideally between 10 to 12 weeks, to determine the amniocity and the chorionicity. Any later, scans may not be able to differentiate the different types of twins.

When to call your obstetrician?

Recognising the signs that require immediate attention is crucial for a healthy twin pregnancy. Signs to look out for include.

• Persistent contractions: Regular and painful contractions could indicate preterm labour.
• Decreased foetal movement: A noticeable reduction in foetal movement may signal potential issues.
• Vaginal bleeding: Any amount of vaginal bleeding should prompt a call to your gynaecologist.
• Severe headache or swelling: These symptoms may indicate gestational hypertension and require immediate attention.

While there are inherent risks in all pregnancies, proper prenatal care can significantly mitigate some of these concerns. Discuss any worries with your obstetrician, and be an advocate for yourself and your babies.