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Concerns When Pregnant with Multiples

Most women who are pregnant with 2 or more babies have healthy pregnancies. But the risk of complications is higher than with a single baby. If you are carrying multiples, know the warning signs of possible problems. If problems do occur, work closely with your healthcare provider. This helps you stay healthy and deliver healthy babies. Baby complications depend on if they share a sac or placenta. Below are some complications that are more likely during a multiple pregnancy, regardless of the type of multiples.

Healthcare provider taking pregnant woman's blood pressure.
Keep up with your prenatal visits to help ensure a healthy multiple pregnancy.

Preterm labor

Going into labor too early in pregnancy is called preterm labor. Preterm labor can cause your babies to be born too soon. The babies may then have health problems. A woman carrying multiples is more likely to have preterm labor. Learn the signs of preterm labor. When caught in time, preterm labor can be managed and even stopped.

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

  • Strong contractions or 4 or more contractions per hour

  • Constant menstrual-like cramping

  • Sudden or constant low-back pain

  • Mucous or bloody vaginal discharge

  • Bleeding or spotting in the second or third trimester


This is a fast rise in blood pressure during pregnancy. If it happens, it's often after 20 weeks of pregnancy. It may be more likely to happen during a multiple pregnancy. Untreated, it can lead to problems that threaten the mother's life. These include seizures, kidney failure, liver rupture, brain bleeding, stroke, fluid in the lungs, and blood-clotting problems. This condition is also dangerous for the babies. This is because it prevents the placenta from getting enough blood to the baby. This prevents the babies from getting enough oxygen and nutrients. As a result, the babies can be born too small (low birth weight). They may have other health problems. Treatment depends on the severity of the condition. In all cases, you and your baby will be closely watched. In some cases, bed rest may be advised. And in severe cases, treatment or delivery in the hospital is needed.

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

  • Swelling in your face or hands

  • Rapid weight gain

  • Little or no urine, or blood in your urine

  • Severe headache

  • Belly (abdominal) pain on your right side

  • Vision problems (flashes or spots or blurred vision)

  • Nausea, vomiting, or both

  • Not feeling the babies moving, or feeling their movements have slowed

Gestational diabetes

This type of diabetes occurs only during pregnancy. Changes in the body cause blood sugar to be too high. This can be a problem during any pregnancy, but there is a higher risk of it with a multiple pregnancy. High blood sugar makes preeclampsia more likely. High blood sugar can also cause the babies to grow too large. This can lead to problems during late pregnancy and during delivery. Babies born to a mother with gestational diabetes may have problems after birth. These include breathing problems and low blood sugar. Controlling blood sugar can prevent these problems. If you have this condition, you may be referred to diabetes specialists. These include a healthcare provider and dietitian. They will discuss treatments with you. This includes eating to control your blood sugar. You may also need medicines.

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

  • You’re thirsty all the time

  • You urinate often and a lot each time

  • You’re tired all the time

  • You have vaginal yeast infections that keep coming back

Placenta problems

The placenta gives the babies nourishment. It also eliminates waste. With a multiple pregnancy, multiple babies may share one placenta. Or each baby may have its own placenta. The most common placenta problems are placental abruption and placenta previa. Placental abruption happens when the placenta starts detaching from the uterus before it’s time to deliver. The result is pain and bleeding, although you can have an abruption without bleeding. With placenta previa, the placenta covers the cervical opening. With either condition, bleeding may happen when the due date nears and the cervix starts to dilate and open. In mild cases, the healthcare provider will watch the mother and babies. If you have a placenta previa, the babies may be delivered right away by C-section. If you have a placenta previa, don't have sex or let anyone check to see if your cervix is dilated. This could cause bleeding.

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

  • Bleeding from the vagina

  • Belly pain

Iron-deficiency anemia

The mother’s body uses iron to make red blood cells for her and her babies. These cells bring oxygen to the babies and to the rest of the body. Anemia is a condition in which the body’s red blood cell count is too low. In pregnant women, this is often caused by too little iron in the blood. So it is called iron-deficiency anemia. If a mother has iron-deficiency anemia that isn't treated, her babies may be born too small. The babies may also have other health problems. This condition is common in a multiple pregnancy. In women carrying multiples, a simple blood test called a CBC (complete blood count) is done. It's routine for all pregnant women, whether they have multiples or not. It's done at one of the first prenatal visits. A repeat hemoglobin and hematocrit are checked again at 28 weeks for all pregnant women. If you test positive for this condition, follow your healthcare provider’s advice for treating it. This will likely include eating foods high in iron and taking iron supplements.

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

  • Feeling tired all the time

  • Dizziness

  • Pale skin

  • Shortness of breath

  • Fast heartbeat

Fetal growth restriction (FGR)

Babies affected by FGR are not growing at a normal rate inside the womb. They are smaller than normal. There are different causes of FGR. These include preeclampsia, shared placenta, and genetic disorders. With a multiple pregnancy, FGR is fairly common. One baby or all babies may be affected. A baby with FGR may have certain health problems. These include low blood sugar and not getting enough oxygen at delivery. They also include trouble fighting infections or keeping a normal body temperature after birth. You will not feel any symptoms of FGR. But you can take steps to help prevent it from affecting your babies. These include:

  • Eat enough food (discuss how much with your healthcare provider).

  • Don't smoke.

  • Get enough rest (discuss how much with your provider).

Online Medical Reviewer: Donna Freeborn PhD CNM FNP
Online Medical Reviewer: Heather Trevino
Online Medical Reviewer: Irina Burd MD PhD
Date Last Reviewed: 2/1/2020
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