Are you also having twins or triplets? (Multiple Pregnancy) Let's talk about this!

When the doctor tells you that you are having more than one baby, that is, twins or triplets (multiple pregnancy), you must have felt both surprised and very happy, right? But at the same time, it is normal to have a little fear and a few questions coming to your mind. You may be thinking things like, "How will I take care of two?", "Will I be able to handle this?" Don't worry, you are not alone. In this article, we will talk about this "multiple pregnancy" in a simple way that you can understand.

What is this multiple pregnancy?

Simply put, a multiple pregnancy is when you are carrying more than one baby at a time. If you are carrying two babies, we call them twins . If you are carrying three babies, we call them triplets . Sometimes, you can carry even more babies in the same pregnancy, which is called high-order multiples . There are usually a few more risks involved in a multiple pregnancy than in a singleton pregnancy. But don't worry, with good medical supervision, all of this can be managed well.

How are these twins and triplets born?

There are two main ways this can happen:

1. Division of a single fertilized egg/ovum: A single egg fertilized by a single sperm divides into two or more before implanting in the wall of the uterus.

2. Multiple fertilizations: Multiple eggs are fertilized by separate sperm at the same time.

These two methods determine whether the twins are identical or fraternal .

Who are identical twins?

Imagine, a single egg is fertilized by a single sperm, and then it splits into two (or more). The babies that form like this are called identical twins. Their genetic material is completely identical. That means they look the same and are the same sex (girls are girls, boys are boys) . It's like a carbon copy!

Who are fraternal twins?

What happens here is that two (or more) separate eggs are fertilized by separate sperm. Now look, the eggs are different, the sperm are different. So the genetic information of the babies that are born is also different. That's why these babies don't look the same, and they can also be mixed as male and female. Just like siblings in the same family, just born on the same day.

In a pregnancy with triplets or more, the babies can all be identical, all be dizygotic, or a mixture of both. This means that if your body releases multiple eggs, more than one of them is fertilized, and one or more of those fertilized eggs splits again, this can happen.

Are identical twins always the same sex?

Yes! Because identical twins are born from the same egg and sperm, they have the same genetic information. The sex of a baby is determined by the type of chromosome in the fertilized sperm. The mother's egg contains an X chromosome. If the father's sperm contains an X chromosome, the baby will be XX (female), and if it contains a Y chromosome, the baby will be XY (male). So, because the same egg divides, each baby will have the same chromosome combination as before.

What factors increase the risk of multiple pregnancy?

There are several factors that increase your chances of having twins or more babies. These may also affect you:

• Age: Women in their 30s sometimes have a tendency to release more than one egg at a time.
• Family history: If you are a twin, or if there are twins in your family (especially on your mother's side), you are more likely to have twins too. This is something that runs in your genes.
• Fertility drugs and treatments: Some infertility treatments, such as In Vitro Fertilization (IVF) , increase the chances of having twins by transferring more than one fertilized egg into the uterus to increase the chances of a successful pregnancy.
• Height and weight: Some studies suggest that women who are taller or heavier than average may have a slightly higher risk of multiple pregnancies.

Recently, as more people are seeking fertility treatment, the number of multiple births has also increased slightly.

How do I know if I'm having twins? What are the signs?

The only way to know for sure if you are having more than one baby is to see a doctor and have an ultrasound scan. This test can clearly see how many babies are inside your uterus.

However, sometimes symptoms can be more severe than in a singleton pregnancy. For example:

• Severe morning sickness and vomiting.
• Rapid weight gain during the first three months of pregnancy.
• Feeling of extreme pain or tenderness in the breasts.
• High levels of a hormone called Human Chorionic Gonadotrophin (hCG) in the blood or urine. This hormone is detected by a pregnancy test.
• High levels of a protein called Alpha-fetoprotein in the blood.

Also, if the doctor hears more than one heartbeat when performing a fetal Doppler scan , he may suspect that it could be twins.

What are the complications associated with the birth of twins?

Anyone can have complications during pregnancy, regardless of how many babies they are carrying. However, doctors consider multiple pregnancies to be higher risk than singleton pregnancies. This does not mean that every mother who is expecting twins will have problems. However, if you are expecting twins, your doctor will check you regularly and be on the lookout for potential complications. They will explain all of the risks to you.

Some of the complications that can be associated with multiple pregnancies include:

• Premature labor and birth: This is the most common complication seen in multiple births. This means that the babies can be born before the 37th week of pregnancy. In the case of twins, completing 37 weeks is the goal of most mothers. Then the babies are more likely to be born healthy and of good weight. Babies born prematurely are also at risk of another complication called low birth weight.

• Preeclampsia or Gestational hypertension: High blood pressure during pregnancy is called hypertension. Your doctor will check your blood pressure regularly to see if you have gestational hypertension. This can sometimes lead to a dangerous condition called preeclampsia . A mother with twins is twice as likely to develop this condition as a mother with a single baby. Also, this condition can occur early in pregnancy or can develop more quickly.

• Gestational diabetes: Diabetes can develop during pregnancy. This is due to the increased amount of hormones secreted by the placenta. The size of the placenta can also affect this. If you have two placentas, your insulin resistance increases.

• Placenta abruption: This is an emergency. It is when the placenta separates from the uterine wall before the baby is born. This condition is more likely to occur in mothers who are carrying twins.

• Fetal growth restriction: Also known as intrauterine growth restriction (IUGR) or small for gestational age (SGA) , this is when one or more of your babies do not grow properly. This can cause the babies to be born prematurely or with low birth weight. This problem occurs in about half of all multiple pregnancies.

Fraternal twins always have two placentas. The risks of pregnancies involving them are similar to those of pregnancies with one baby, but are slightly higher.

Identical twins can have one placenta (70% of the time) or two placentas (30% of the time). The risks of identical twins with two placentas are similar to those of fraternal twins.

Special risks of identical twins who share a single placenta (Monochorionic)

Identical twins who share a single placenta (we call this monochorionic) have several unique risks:

• Twin-Twin-Transfusion-Syndrome (TTTS): This condition occurs in 5% to 15% of cases. This is due to vascular communications between the twins at the placental level. Due to this connection, the twins share their blood. If this happens, if nothing is done, there is a 90% risk that the twins will die in the womb. There are in-utero procedures to reduce this risk.

• Twin-Anemia-Polycythemia Sequence (TAPS): This is also a condition where blood flows from one twin to the other due to a placental connection. In this, when one baby is anemic (low red blood cells), the other baby becomes polycythemic (high red blood cells). When this happens, various treatments/interventions are used.

• Selective IUGR: This is another condition seen in identical twins who share a single placenta. While one baby grows well, the other baby's growth is greatly reduced.

• (Twin-Reversed-Arterial-Perfusion - TRAP) syndrome: In this condition, one baby's heart pumps blood to both babies. The other baby does not have a heart and therefore does not survive after birth. The health of the baby with a normal heart can vary. Fortunately, this syndrome is very rare (about 1 in 20,000 to 40,000) and can be treated in the womb.

• Monoamniotic: Identical twins who share a single placenta can sometimes be in the same gestational sac. This is called Monochorionic-Monoamniotic . This condition occurs in about 1% of multiple pregnancies. In this case, there is a higher risk for one or both babies.

Your doctor diagnoses all of these conditions through ultrasound scans.

Are there more chances of delivering the baby by cesarean section (C-section) when having twins?

A cesarean section is a procedure in which a baby is delivered through an incision in the abdomen. This can be done for a variety of reasons, but it is most commonly done in multiple births. A cesarean section is more likely to be performed in a twin pregnancy than in a singleton pregnancy. However, even in a singleton pregnancy, a cesarean section is sometimes the safest way to deliver a baby.

Most of the time, babies are born in a breech position (head down). Also, if you have any complications during your pregnancy, and a vaginal birth is not safe for you or your baby, you may need to have a cesarean section. Your doctor will monitor you closely until you are ready to give birth and talk to you about the best way to deliver your baby.

What should I do to stay healthy when expecting twins?

Eating nutritious foods, getting enough rest, and seeing your doctor regularly are all important for a healthy pregnancy for any expectant mother. These things are even more important for a mother who is expecting twins.

If you are carrying twins, you need to be especially careful about your diet. It is important to get enough protein and fluids (water). You also need to eat enough extra calories to support your growing baby. As a general rule, each baby needs about 300 extra calories a day . That means if you are carrying twins, you need about 600 extra calories a day. Talk to your doctor about your diet and the specific amounts you need for a healthy pregnancy.

Mothers of twins may experience some of the common discomforts of pregnancy (e.g., backaches, fatigue). It's important to take good care of yourself and get plenty of rest.

In some cases, it is best to see a specialist who has experience with multiple births. This will ensure that you and your baby receive the best possible care. It is very important to receive regular, intensive antenatal care during a multiple pregnancy. Ask your family doctor or OBGYN for advice on this.

Can you exercise when you have twins?

Exercise is important during any pregnancy. In most cases, you can still exercise while you're pregnant. Light, low-impact exercise is best. For example:

• Swimming
• Walking
• Prenatal yoga

While exercise is good, it's best to talk to your doctor about what exercises are right for you. Some strenuous exercises may not be good for you during a pregnancy with twins. For example:

• Jogging
• Aerobics that include jumping

Also, keep in mind that if you experience any complications, you may need to change your exercise routine.

The most important things to remember (Take-Home Message)

Having twins or triplets is truly a blessing! Yes, there may be some challenges, but you can overcome them all.

The most important thing is to follow your doctor's instructions and go to the clinics on time. They will take good care of you and your baby.

• Eat and drink well, especially with protein and extra calories.
• Get plenty of rest. Rest is essential because it puts extra stress on your body.
• Do light exercise, but only start after consulting your doctor.
• If you notice anything unusual or different, tell your doctor immediately. Don't ignore even the smallest thing.
• Talk to your husband, family, or doctor about your fears and concerns. Don't keep them bottled up.

You are not going on this journey alone. There are many people to help you and take care of you. Enjoy this amazing experience!

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