Prenatal care for a multiple pregnancy

A multiple pregnancy is a high-risk pregnancy. This means it has a higher risk for problems. Prenatal care will need to include:

• More prenatal visits. This helps your healthcare provider closely watch your health and the health of your babies. It’s important to check their growth in the womb. Your provider will watch for problems. They will check your weight and nutrition.

• Repeated ultrasounds. These are used to check the growth of the babies. They check the volume of amniotic fluid. These tests start in your second trimester. You may have an ultrasound every 4 to 6 weeks.

• Tests to check your health. You may have earlier blood sugar tests. This is to see if you have gestational diabetes. You may be tested earlier for iron-deficiency anemia. Your provider will also check your blood pressure often.

• Tests to check the health of the babies. You may have amniocentesis. Or you may have chorionic villus sampling (CVS). These are done to test for birth defects. You may have a nonstress test. This is to check the heart rates of the babies.

• Preparing for birth. A multiple pregnancy raises the risk for preterm birth. It raises the risk for cesarean section (C-section). It’s important to talk about these with your healthcare provider.

At prenatal visits, you’ll need guidance on:

• Nutrition

• Prenatal vitamins

• Activity

• Expected weight gain

Risks of a multiple pregnancy

Being pregnant with twins or more raises your risks for all problems that can happen in pregnancy. This is why you need extra prenatal care. Many of the problems can be managed better if they are found early.

Risks during pregnancy

• Low red blood cell count (anemia)

• Gestational diabetes

• Gestational high blood pressure (preeclampsia)

• Severe morning sickness and fatigue

• Preterm birth (before 37 weeks)

• Baby is not gaining weight normally (fetal growth restriction)

• Monochorionic babies—this is when babies share a placenta and amniotic sac, which can raise the risk for twin-to-twin transfusion syndrome (TTTS) (this is uneven blood flow between the twins)

Risks after birth

• Health problems of premature babies and NICU care

• Postpartum depression

• Heavy bleeding after birth (postpartum hemorrhage)

• Low birth weight

• Birth defects

When to call your healthcare provider

Call your healthcare provider right away if you have any of these:

• Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

• Symptoms of postpartum depression

• Heavy bleeding

• Eclampsia symptoms

• Headaches

• Increase in blood pressure