At first, Katie Blair and her husband thought it was a joke. The parents of two were in the doctor’s office for an ultrasound to monitor Blair’s third pregnancy, which was just eight weeks along, when the sonographer told them she heard two heartbeats.
“We asked if [she was] kidding and sat there in shock,” says Blair, a 35-year-old social work graduate student in East Lansing, Michigan. “Then we realized that’s something that [she] probably wouldn’t joke about. “It was very surprising.”
Today, seven months later, reality is still setting in. “I look at this belly and I think, ‘This is pretty incredible that there are two babies in there,'” says Blair, who’s expecting fraternal twin boys before the end of February. “It’s not something that happens to most people who get pregnant.”
[See: The Fertility Preservation Diet: How to Eat If You Want to Get Pregnant.]
Indeed, each year, only about 135,000 twin pairs are born in the U.S., making up about 3.4 percent of all live births, according to the latest data from the Centers for Disease Control and Prevention. Triplets, quadruples and other multiples are far rarer, making up just over 0.1 percent of all live births, the CDC reports.
While historically twins have accounted for about 2 percent of all live births, the incidence more than doubled between 1980 and 2009, according to the CDC. The surge is attributable to the advent and availability of in vitro fertilization, which typically involved doctors transferring multiple embryos — or fertilized eggs — from the lab to a woman’s uterus at once. The goal was to boost the woman’s chances of delivering a baby, since it wasn’t clear which embryos would make it, says Dr. Kate Devine, a District of Columbia-based reproductive endocrinology and infertility specialist at Shady Grove Fertility, where she co-directs the research program. “It was like trying to choose a marathon team based on their sprint time,” she says. Sometimes, more than one would cross the finish line.
[See: In Vitro Fertilization Grows Up.]
Today, however, most clinicians only transfer a single embryo at a time, since technological advances allow embryos to survive longer in the laboratory and to be tested more thoroughly before transfer. As a result, most twin births now are due to nature. Here’s what to know about the months following the news that you’re pregnant … with multiples.
1. You are technically a high-risk patient.
The risk of many potential pregnancy complications — including preterm delivery, cesarean birth, pre-eclampsia (a blood pressure disorder) and gestational diabetes — is elevated among women carrying multiples, according to the American College of Obstetricians and Gynecologists. That’s why you need to be especially careful about following your OB-GYN’s recommendations for visits, screenings and other care. “With that extra diligence, we can hopefully keep risks of adverse outcomes at a minimum,” Devine says.
2. You should ask if you have multiple placentas.
While all identical twins share a placenta, fraternal twins or other multiples may not — and sharing has implications for their health, since one developing baby may get the shorter end of the nutrient-and-blood stick, says Dr. Mary Norton, president of the Society for Maternal-Fetal Medicine and a perinatologist and medical geneticist at the UCSF Medical Center. “Like any siblings,” she says, “if they’re sharing, they don’t always share well.” In that case, moms-to-be need closer and more frequent monitoring.
3. There’s a good chance you’ll deliver early.
The most common risk of carrying multiples is preterm delivery. “For each additional fetus that’s in there, you deliver about a month earlier,” Norton says, noting that, on average, twins deliver around 36 weeks instead of the 39 to 40 weeks that’s considered full-term for singletons. “Most babies do fine [when they’re delivered at 36 weeks], but they’re at higher risk for complications,” Norton says, such as respiratory, cognitive and other short- and long-term problems. Again, that means it’s important to talk to your doctor about what symptoms might signal an early labor. “We worry a little bit more about things that might be common symptoms that could be premature labor if you’re pregnant with twins,” Norton says.
4. You’ll be a regular at the doctor’s office.
“Expect to be in the doctor’s office longer and more often,” says Blair, who visited her provider monthly until 32 weeks and now goes weekly to get various tests including ultrasounds, which alone take twice as long as a single pregnancy. Monthly visits are typical if your twins don’t share a placenta, Norton says; if they do, double that frequency.
5. You’ll get bigger faster.
Upon seeing Blair’s belly, a woman commented, “Any day now!” In reality, Blair was only 28 weeks along, but, as is typical with twins, appeared to be six to eight weeks ahead of where she’d be, size-wise, if she were only pregnant with one. “Women pregnant with multiples should be prepared to have a lack of clothes at the end — especially tops,” says Blair, who now relies on leggings, long tank tops and maternity shirts. “[My tops] no longer cover my full belly.” Her exercise routine also took a hit earlier this time around, which is to be expected, although movement is still recommended during pregnancy with multiples, says Dr. Stephanie Romero, an OB-GYN and assistant professor at the University of South Florida Morsani College of Medicine. “[Women] will be more fatigued, their hips will hurt, their joints will hurt,” she says. “It’s just not going to be the same.”
6. “Three square meals” will become a foreign concept.
For each additional fetus, most women need to tack on about 300 extra calories to their diets, Romero says. To consume them, “let go of this concept of breakfast, lunch and dinner,” she says, and embrace lots of small meals instead. The method tends to better suit your crowded belly and your increased likelihood of nausea, vomiting and heartburn due to your body’s excess hormones. You’ll also need to take additional prenatal vitamins like folic acid, experts say.
[See: 10 Weird Mind and Body Changes That Are Totally Normal During Pregnancy.]
7. Mixed emotions are normal.
Blair enjoyed her first two pregnancies, but this one is different. “It was more terrifying and overwhelming to think about it,” she says, not to mention more physically uncomfortable. N egative emotions can also be compounded by excess hormones and then lead to guilt for not being elated. “Some of the feelings you have that don’t feel good like shocked and sad or not excited — that’s normal,” Blair says. What’s helped her cope most is connecting with other moms and moms-to-be of twins. “Yes, this isn’t what I imagined,” she says, “but once those babies are here, I’m sure I won’t be able to imagine it any differently.”
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7 Things You Need to Know If You’re Pregnant With Twins originally appeared on usnews.com
