Multiple Pregnancy

What is Multiple Pregnancy?

Multiple pregnancy refers to when a woman have more than one baby during their pregnancy. 

This can range from twins (two babies) to septuplets (seven babies) or even more. It happens when more than one egg is fertilised or one egg splits into two or more embryos.

Understanding multiple pregnancies is crucial for expecting parents as it often comes with increased risks and requires special medical care. It also prepares parents for the logistical and emotional challenges of caring for multiple newborns simultaneously.

Types of Multiple Pregnancy

• Twins: This is the most common type of multiple pregnancy, occurring when a woman carries two babies. They can be either identical or fraternal. 
• Conjoined twins: Conjoined twins are a rare phenomenon where identical twins are physically connected. This happens when the splitting of the fertilised egg is incomplete. The connection can occur at different body parts, and the degree of connection can vary significantly. The survival rate of conjoined twins is typically low, and surgical separation can be complicated and risky.
• Triplets: This is when three babies are being carried simultaneously. They can be all identical, all fraternal, or a combination. 
• Quadruplets and more: While less common, pregnancies can involve four, five, six, or even more babies. The specifics of these pregnancies vary greatly.

Causes and Factors Influencing Multiple Pregnancy

Natural Causes

Naturally occurring multiple pregnancies are primarily due to the release of more than one egg during a woman's menstrual cycle, which is then fertilised by different sperm. This leads to fraternal twins or multiples. Identical twins or multiples happen when a fertilised egg splits.

Role of Fertility Treatments

Fertility treatments like In-Vitro Fertilisation (IVF) or ovulation-stimulating medications can increase the chances of multiple pregnancies. These treatments can lead to the release of multiple eggs or the implantation of multiple embryos.

Maternal Age

Women in their 30s and 40s are more likely to have multiple pregnancies naturally, primarily because hormonal changes can release more than one egg.

Family History

Women with a family history of multiple pregnancies are likelier to have multiple.

Race

Certain races, such as Africans, have higher rates of multiple pregnancies. Conversely, Asians have lower rates.

Symptoms Associated with Multiple Pregnancies

While symptoms can vary from woman to woman, several signs and symptoms might suggest a multiple pregnancy. 

It's important to note that having these symptoms doesn't necessarily mean you're carrying multiples, and many women have normal pregnancies with these symptoms. Here are some common symptoms associated with multiple pregnancies:

• Larger, faster weight gain: A woman carrying multiples might gain weight faster and appear larger than expected for her stage of pregnancy.
• Severe morning sickness: While morning sickness is a common pregnancy symptom, women carrying twins may experience it more severely due to higher hormone levels.
• Early and frequent foetal movements: Women carrying multiples might feel their babies moving earlier and more frequently. However, this can vary greatly from woman to woman.
• High Alpha-Fetoprotein (AFP) levels: AFP is a protein the baby produces during pregnancy. Elevated levels might indicate multiple pregnancies, although other reasons exist for high AFP levels.
• Extreme fatigue: While fatigue is common in all pregnancies, it might be more pronounced in multiple pregnancies due to the body's extra work to support the growth of more than one baby.
• Measuring large for gestational age: When a healthcare provider measures your uterus during prenatal visits, if it's larger than expected for your stage of pregnancy, it might be due to multiples.
• Abnormally high results on a pregnancy test: Some (but not all) pregnant women carrying multiples have higher levels of hCG (the hormone measured in pregnancy tests), which can result in a faster positive result.

Diagnosis of Multiple Pregnancy

The most definitive way to confirm a multiple pregnancy is through an ultrasound, which can show the presence of multiple foetuses. This is usually done during the first trimester.

Importance of Prenatal Care

Prenatal care is crucial in any pregnancy, but it's especially important for multiple pregnancies because of the higher risk of complications. Regular check-ups allow healthcare professionals to monitor the health of both the mother and babies' health and plan for safe delivery.

Potential Complications and Risks of Multiple Pregnancy

Health Risks to the Mother

Mothers carrying multiples are at a higher risk for several health issues, including: 

• Preeclampsia: a condition characterised by high blood pressure and signs of damage to another organ system, often the liver and kidneys.
• Gestational diabetes: This type of diabetes develops during pregnancy and can increase the risk of type 2 diabetes later in life.
• Maternal anaemia: The body may not produce enough red blood cells to support the growth of multiple babies, leading to anaemia.
• Postpartum haemorrhage: The risk of excessive bleeding after delivery is higher in multiple pregnancies.

Risks to the Babies

Multiple pregnancies can increase the risk of certain complications for the babies, including: 

• Preterm birth: Multiples are more likely to be born prematurely, which can lead to numerous health issues for babies.
• Low birth weight: Multiples are often smaller than single babies due to uterine space constraints.
• Congenital disabilities: The risk of certain birth defects is slightly higher in multiples.

Preterm labour and birth

Preterm labour and birth is a common complications of multiple pregnancies. Preterm babies are those born before the 37th week of pregnancy. They may face challenges like breathing difficulties, digestive problems, and long-term developmental issues.

Twin-to-twin transfusion syndrome

Twin-to-twin transfusion syndrome (TTTS) is a condition that can occur in identical twin pregnancies when the babies share a placenta. It occurs when there's an imbalance in the blood flow between the twins, with one twin receiving too much blood and the other too little. It can lead to serious complications and requires specialised medical care.

Managing a Multiple Pregnancy

• Regular prenatal care: Regular prenatal check-ups are crucial in managing multiple pregnancies. These visits allow healthcare providers to monitor the mother's and baby's health, track the baby's growth and development, and identify potential complications early.
• Dietary considerations and weight gain: Expecting mothers of multiples need more calories and nutrients. A diet rich in protein, calcium, iron, and folic acid is important. Weight gain should be monitored and managed under the guidance of a healthcare provider as it differs from singleton pregnancies.
• Exercise and rest recommendations: Regular, mild exercise can help manage weight, increase circulation, and improve overall health. However, high-intensity activities should be avoided to minimise the risk of preterm labour. Adequate rest is also essential due to the increased physical demands of multiple pregnancies.
• Preparing for the possibility of a caesarean section or other complications: Due to the increased risks associated with multiple pregnancies, expecting parents should prepare for a caesarean section or other interventions during delivery. Discussing birth plans and potential scenarios with healthcare providers is essential.

Preparing for Multiple Newborns

Caring for multiple newborns can be overwhelming. Parents should be prepared for less sleep, increased feeding times, and the need to juggle attention between multiple infants. It's also common to experience emotional challenges such as stress and anxiety.

Multiple births mean more expenses. From diapers to cribs to clothing, parents should prepare financially. Logistical preparations may include arranging for help from family, hiring a nanny, and ensuring the babies have enough space at home.

Managing stress is important for new parents of multiples. Some tips include taking time for self-care, connecting with other parents of multiples for support and advice, and seeking professional help if overwhelming feelings persist. Accepting help and sharing caregiving responsibilities with a partner or other family members is also important.