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Pregnancy and Childbirth: Special Concerns When You’re Having Multiples

Most women who are pregnant with two or more babies have healthy pregnancies. However, the risk of complications is higher than with a single baby. If you are carrying multiples, know the warning signs of possible problems. If problems do develop, work closely with your health care provider. This helps you stay healthy and deliver healthy babies. Below are some complications that are more likely during a multiple pregnancy. Read on to learn how to manage them or help make them less likely.

Pregnant woman sitting on exam table. Healthcare provider is taking woman's blood pressure.
Keep up with your prenatal visits to help ensure a healthy multiple pregnancy.

Preterm Labor

Going into labor too early in pregnancy is called preterm labor. Preterm labor can cause your babies to be born too soon. This can cause the babies to have health problems. A woman carrying multiples is more likely to have preterm labor. Learn the signs of preterm labor. When caught in time, preterm labor can be managed and even stopped.

Call your health care provider right away if you have any of the following signs of preterm labor:

  • Strong contractions or four or more contractions per hour and each contraction lasting one minute or longer

  • Constant menstrual-like cramping

  • Sudden or constant low-back pain

  • Mucous or bloody vaginal discharge

  • Bleeding or spotting in the second or third trimester


This is a rapid rise in blood pressure and proteins in your urine during pregnancy. If it occurs, it is usually after 20 weeks of pregnancy. If your blood pressure is elevated and there are no proteins in your urine before 20 weeks of pregnancy, you likely have had undiagnosed hypertension or you may have gestational hypertension. Preeclampsia may be more likely to occur during a multiple pregnancy. Untreated, it can lead to problems that threaten the life of the mother. These include seizures, kidney failure, liver rupture, and blood clotting problems. This condition is also dangerous for the babies. This is because it prevents the placenta from getting enough blood. This keeps the babies from getting enough oxygen and nutrients. As a result, the babies can be born too small (low birth weight). They may have other health problems. Treatment depends on the severity of the condition. In all cases, you and your baby will be monitored. In some cases, bed rest may be recommended. And in severe cases, treatment in the hospital is needed.

Call your health care provider right away if you have any of the following signs of preeclampsia:

  • Swelling in your face or hands

  • Rapid weight gain (about 1 pound or more in a day)

  • Little or no urine, or blood in your urine

  • Severe headache

  • Abdominal pain especially on your upper right side

  • Vision problems (flashes or spots or blurred vision)

  • Nausea, vomiting, or both

  • Not feeling the babies moving, or feeling their movements have slowed

Gestational Diabetes

This type of diabetes occurs only during pregnancy. Changes in the body cause blood sugar to be too high. All pregnant women are screened for diabetes during normal prenatal care. Diabetes can occur during any pregnancy, but it is even riskier in the case of multiples. High blood sugar makes preeclampsia more likely. High blood sugar can also cause the babies to grow too large. This can lead to problems during late pregnancy and during delivery. Babies born to a mother with gestational diabetes may have problems after birth. These include breathing problems and low blood sugar. Controlling blood sugar can prevent these problems. If you have this condition, you’ll likely be referred to diabetes specialists. These include a doctor and dietitian. They will discuss treatments with you. This includes eating to control your blood sugar. You may also need medications.

Call your health care provider right away if you have any of the following signs of diabetes:

  • You’re thirsty all the time

  • You urinate often and a lot each time

  • You’re tired all the time

  • You have vaginal yeast infections that keep coming back

Placenta Problems

The placenta gives the babies nourishment. It also eliminates waste. With a multiple pregnancy, multiple babies may share one placenta. Or each baby may have its own placenta. The most common placenta problems are abruptio placenta and placenta previa. Abruptio placenta occurs when the placenta starts detaching from the uterus before it’s time to deliver. The result is pain and bleeding. With placenta previa, the placenta’s position covers the cervical opening. With either condition, when the due date nears and the cervix starts to dilate and open, bleeding may occur. In mild cases, the health care provider will monitor the mother and babies and you can still tray to deliver vaginally. In severe cases, the babies may be delivered right away by C-section. In any case, if you have this problem, you should avoid intercourse until after delivery.

Call your health care provider right away if you have any of the following signs of placenta problems:

  • Bleeding from the vagina

  • Abdominal pain

Iron-Deficiency Anemia

The mother’s body uses iron to make red blood cells for her and her babies. These cells bring oxygen to the babies and to the rest of the body. Anemia is a condition in which the body’s red blood cell count is too low. In pregnant women, this is often caused by too little iron in the blood. This is called iron-deficiency anemia. The condition is common in a multiple pregnancy. If a mother has a mild form of iron-deficiency anemia, it can usually be treated by eating foods high in iron and taking iron pills. Severe anemia may require IV iron or even a blood transfusion. Severe anemia that is not treated can cause a woman’s babies to be born too small. The babies may have other health problems.  A simple blood test called a CBC (complete blood count) is done to test for anemia. It is a routine test performed at one of the first prenatal visits. This test may be done again at about weeks 26 to 28. If you test positive for this condition, follow your health care provider’s advice for treating it.

Call your health care provider right away if you have any of the following signs of anemia:

  • Feeling tired all the time

  • Dizziness

  • Pale skin

  • Shortness of breath

  • Fast heartbeat

Intrauterine Growth Restriction (IUGR)

Babies affected by IUGR are not growing at a normal rate inside the womb. They are smaller than normal. There are different causes of IUGR. These include preeclampsia, shared placenta, and genetic disorders. With a multiple pregnancy, IUGR is fairly common. One baby or all babies may be affected. A baby with IUGR may have certain health problems. These include low blood sugar and not getting enough oxygen at delivery. They also include trouble fighting infections or keeping a normal body temperature after birth. You will not feel any signs or symptoms of IUGR. But you can take steps to help prevent it from affecting your babies. These include:

  • Eat enough food (discuss how much with your health care provider).

  • Do not smoke.

  • Get enough rest (discuss how much with your health care provider).

Author: StayWell Custom Communications
Last Annual Review Date: 9/18/2014
Copyright © The StayWell Company, LLC. except where otherwise noted.
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