A multiple pregnancy is more complicated than a single pregnancy. Women carrying two or more babies usually require more prenatal care than those facing a single birth. Although multiple pregnancies are generally classified as high-risk pregnancies, many twin pregnancies are no riskier than a single pregnancy.

With today’s technology, many women learn they are carrying more than one baby much earlier in their pregnancy. For a naturally occurring multiple pregnancy, a woman may notice an earlier weight gain or enlarged abdomen. Some women may have severe pregnancy symptoms, such as intense morning sickness or more breast tenderness.

A woman’s physician may detect a multiple pregnancy from a second heartbeat or unexpectedly higher levels of human chorionic gonadotropin (hCG) hormone in blood tests. This normally increases during pregnancy, and more babies make it rise more quickly. Ultrasound can usually detect most cases of multiple pregnancy by the beginning of the second trimester (14 weeks). Women who use fertility drugs or assisted reproductive technology methods are aware of the greater likelihood of multiples and are more attuned to the signs. In addition, their obstetrician-gynecologist (ObGyn) will be closely monitoring these women due the manner in which the baby was conceived.

Once a multiple pregnancy is confirmed, a woman should make certain adaptations to continue a healthy pregnancy. These changes include:

• Nutrition. Women should continue to eat a healthy diet and drink plenty of water. The American College of Obstetricians and Gynecologists recommends that women with multiple pregnancies consume about 300 more calories a day than women carrying one baby. The recommendation for a single pregnancy is 2,700 to 2,800 calories a day. Some ObGyns may increase a woman’s prenatal vitamin intake as well.
  
  
• Weight gain. Women with multiple pregnancies should gain more weight than women with single pregnancies. A woman of normal weight is usually advised to gain between 25 and 35 pounds (11 to 16 kilograms) during pregnancy. For twins, she should probably gain 35 to 45 (16 to 20 kilograms) pounds, and for triplets 50 to 60 pounds (23 to 27 kilograms). Gaining the weight in earlier weeks of gestation is especially important in multiple pregnancy. Multiples are more likely to be born prematurely and underweight so increasing the babies’ size and weight can help their health. 
  
  
• Rest. Pregnant women are advised to rest more. As a multiple pregnancy advances, a woman’s ObGyn may suggest less activity and more frequent rest to help improve uterine blood flow and increase the birth weight of the babies. If the ObGyn detects signs of premature labor (such as contractions or cervical changes), the woman may be subject to complete bed rest.
  
  
• Physician visits. A woman with a multiple pregnancy usually requires more physician visits. During the second trimester, she will usually have two visits a month and increase that to weekly appointments during the third trimester. This may be further increased for women with triplets or more, or for those who are considered at increased risk for complications. A woman may want to find an ObGyn who specializes in high risk pregnancies (a maternal-fetal specialist).

ObGyns monitor fetal and maternal health as they would with a single pregnancy. Blood pressure checks and urine tests are used to watch for signs of preeclampsia, a dangerous condition of pregnancy characterized by high blood pressure and larger than normal amounts of protein in the urine. Blood tests can be used to screen for certain birth defects (e.g., Alpha fetal protein levels) and to detect hormone levels (e.g., progesterone). Certain prenatal procedures, such as chorionic villus sampling or amniocentesis, may be performed but can be more difficult for multiple pregnancies.

ObGyns also perform more frequent cervical examinations to monitor for preterm labor and for changes in the length, strength and position of the cervix. A woman with a multiple pregnancy will probably have more frequent ultrasound examinations as well. Ultrasounds can help assess uterine growth, fetal development and position, and detect any difference in growth rates among the babies. 

Each woman’s multiple pregnancy is different. The necessary prenatal care, tests and monitoring will be determined by her ObGyn based on the mother and babies’ conditions. After the babies are born, it is also important that the new parents are prepared for the challenges of multiples, especially if any of the babies have complications. Depression and anxiety are common among parents of multiples as they cope with the stress and added expense of complicated births. Parents who feel overwhelmed are encouraged to seek out support groups or professional help to cope.