A multiple pregnancy is when a woman is pregnant with two or more fetuses. Twins are the most common type of multiple pregnancy. So-called “higher-order” pregnancies (when a woman is carrying triplets, quadruplets, quintuplets, or more) are less common.

The risk for certain complications during and after pregnancy is higher in multiple pregnancies. To lessen these risks your doctor will see you more often than a woman carrying one baby.

Twins in Utero

© 2009 Nucleus Medical Media, Inc.


Multiple pregnancies occur when a single fertilized egg divides and develops into two or more fetuses (identical twins) or when more than one egg is fertilized by a different sperm (fraternal twins). Triplets, quadruplets, and quintuplets can be identical, fraternal, or a combination of both.

Triplets in Utero

Triplets in Utero
© 2009 Nucleus Medical Media, Inc.

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. The following factors increase your chance of having a multiple pregnancy. If you have any of these risk factors, tell your doctor:

  • Use of fertility treatments
  • A previous multiple pregnancy
  • A family history of multiple births
  • More than one previous pregnancy
  • African-American race
  • Older age


If you experience any of these symptoms do not assume it is due to a multiple pregnancy. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.

Symptoms include the following:

  • More rapid weight gain than expected in the first trimester
  • Larger than expected uterus
  • Severe morning sickness
  • More fetal movement than with a singleton pregnancy


Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your doctor may refer you to a healthcare professional who has experience with multiple pregnancies.

Most multiple pregnancies are discovered during an ultrasound]]> examination. An ultrasound examination is a test that uses sound waves to see how the fetus is developing. An ultrasound can detect more than 95% of multiples by the second trimester of pregnancy.

Other tests that may detect a multiple pregnancy include:

  • An abnormal result on certain blood tests done near the 16th week of pregnancy
  • Hearing more than one heart beat during a routine examination



Multiple pregnancies have a greater risk for certain complications. If you experience any of these conditions, your doctor will discuss the best treatment plan for you.

Preterm Labor

Most multiple births are preterm (before the end of 37 weeks of pregnancy). Babies born preterm have a higher risk for many health problems. To delay preterm birth, your doctor may suggest bed rest at home or in a hospital or prescribe certain drugs. If labor threatens to occur before 34 weeks of pregnancy you may be given steroid medication to help your babies’ lungs mature.

Gestational Diabetes

Gestational diabetes]]> is a disorder in which the body becomes less sensitive to insulin resulting in high blood sugar levels. Gestational diabetes treatment aims to return blood sugar levels to normal through diet, exercise, blood sugar level testing, and sometimes insulin shots.


]]>Preeclampsia]]> is a condition occurring during pregnancy when a woman has high blood pressure and more than normal amounts of protein in her urine. Treatment may include drugs, rest, and early delivery of the baby.


More than one fetus in the uterus increases the chances that one of them will be unable to turn head down. A ]]>breech presentation]]> increases the chance of needing a ]]>cesarean]]> delivery.

Twin Twin Transfusion Syndrome (TTTS)

Twins sometimes share vessels in the placenta. If this sharing is unequal, this syndrome can develop. In TTTS, one twin transfuses (donates blood) to the other. The donor twin becomes anemic and the receiving twin develops problems of having too much blood and fluid in it’s body.


To help reduce your chance of having health problems during a multiple pregnancy, take the following steps:

  • Get early and regular prenatal care so your doctor can closely monitor your pregnancy.
  • Follow general pregnancy nutrition advice, including getting more calcium, folic acid, protein, and iron in your diet.
  • Gain the appropriate amount of weight, especially in the first 20-24 weeks of pregnancy.