Pregnancy Risk Factors: Multiple Gestation (Twins, Triplets, etc.)

What you need to know to keep you and your babies safe

Everyone loves to see a cute set of identical twins running around in their matching outfits. While twins, triplets and other multiple babies are always adorable, their parents can often tell you that there is much more to the story than simply having an abundance of baby energy around the house.

A multiple pregnancy, defined as a pregnancy with more than one fetus, is exciting, but it can also come with some increased risks for both mother and the baby. The management of a multiple pregnancy begins with the first prenatal visit and continues through the postpartum period. With 32 out of every 1,000 births being twins, it’s time to spread awareness about what parents can expect during a multiple pregnancy.

What are the causes of multiple gestation pregnancy?

Approximately 88 out of every 100,000 live births come from someone having 3 or more babies at the same time. Although multiple pregnancy was once rare, they’re becoming more common because of the introduction of ovulation-stimulating medicines, which increase the chance of conceiving more than 1 baby at a time.

The same is also true of other reproductive technologies. In vitro fertilization (IVF) is one of the most common causes of a multiple pregnancy. As such, it’s important to talk with your partner and doctor before undergoing IVF about any concerns you may have about carrying more than 1 baby.

There are other possible causes of a multiple pregnancy that are unrelated to fertility treatments. Genetics play a role in who has multiples, so you’ll want to know if anyone in your family has a history of a multiple pregnancy.

Women over the age of 30 are more likely to conceive multiple embryos. Since it is becoming more common for women to wait to have babies, doctors have been seeing more multiple pregnancies in their offices. Women who have already had a previous pregnancy could be more likely to have multiples as well.

What are the most common multiple pregnancy complications?

The management of a multiple pregnancy includes taking a look at the possible complications you might face. Although many women make it through a multiple pregnancy without any problems, carrying more than 1 baby raises your risk for these potential health concerns:


The concept of a “vanishing twin” sounds like a myth, but it actually happens. Sometimes, more than 1 fetus is found on the initial ultrasound, but follow-up ultrasounds show only one fetus. If this phenomenon occurs early on in pregnancy, there is little risk to the mother or the surviving fetus, as the fetal tissue from the “vanishing twin” is simply reabsorbed.

If it occurs during the second or third trimester, the pregnancy may be considered higher risk and closer monitoring may be required. Miscarriage risks are higher in a multiple pregnancy than in pregnacies with only 1 fetus. Symptoms of miscarriage include cramping and bleeding. If you experience these symptoms during pregnancy, make sure you contact your doctor right away.

Preterm labor

Slightly more than 3 out of 5 pregnancies end in preterm birth, and the rate is even higher when there is more than 1 baby. Preterm multiples are often smaller than average, and they may require special medical care until their organs mature and they gain weight.


Because your body is nourishing more than 1 baby, it makes sense that you’d be at higher risk for anemia. You can help combat this by taking prenatal vitamins and eating a nutritious diet.

Gestational hypertension

High blood pressure during pregnancy places you at higher risk for further complications such as premature placental detachment, also known as placental abruption. Placental abruption is an emergency situation where your placenta becomes partially or fully detached from your uterus, putting your baby’s life at risk. If you have gestational hypertension, your doctor will monitor you more closely throughout your pregnancy for signs of placental detachment.

Gestational diabetes

Any pregnant woman can develop gestational diabetes, but it’s more likely with multiple pregnancies. Babies born to mothers with gestational diabetes tend to be bigger, which increases the risk of a c-section.

Postpartum hemorrhage

During a multiple gestation pregnancy, your uterus and placenta grow larger than average to accommodate the extra babies. While this growth is necessary to nourish your babies, it also comes with increased risks. Excessive bleeding, known as postpartum hemorrhage, may require you to have a blood transfusion after giving birth. During your postpartum period, your medical team should monitor your recovery to ensure that prompt action is taken at the first sign of hemorrhaging.

What can doctors do to help prevent complications?

Multiple gestation pregnancies are usually classified as high risk. This means that your doctor will want to monitor you closely, which may mean frequent ultrasounds and testing to make sure everything is progressing normally. If you do develop a complication, your doctor will guide you through the next steps to lower the risk for you and your baby.

Parents have many different reactions to the news that they’re carrying multiple babies. It’s common to experience a roller coaster of feelings from excitement to fear. If you have concerns, make sure to talk with an experienced OB-GYN.

At All About Women, we have more than 20 years of experience helping mothers welcome healthy babies into the world. If you live in the Gainesville area, contact our office today to schedule an appointment with one of our qualified OB-GYNs.