Pregnancy discomforts and complications with twins

• Morning sickness - Because you will be producing higher quantities of pregnancy hormones than with a single pregnancy you are more likely to suffer from morning sickness and it may be more severe than most

• Varicose veins - Your bigger womb and greater increase in blood volume will put more pressure on your veins than in most single pregnancies, so you are more likely to develop the unpleasant common pregnancy discomforts of varicose veins and haemorrhoids (varicose veins in the anus)

• Excess amniotic fluid- With twins it is more likely that you will have an excess of amniotic fluid in your womb in the second half of pregnancy, which would exacerbate the usual pregnancy discomforts associated with the size and weight of your womb (indigestion, shortness of breath, varicose veins, aches and pains)

Pregnancy complications that are more likely

• Anaemia - Another common pregnancy complaint, but one that is not serious and is very easily treated, anaemia is more likely to occur in a twin pregnancy because of the higher demand for an increased blood supply, requiring plenty of iron

• High blood pressure and pre-eclampsia - Carrying twins involves and increased likelihood of developing problems with high blood pressure and pre-eclampsia. As a twin pregnancy mum your ante-natal checks will be particularly thorough in checking for signs of high blood pressure related illnesses

• Congenital abnormalities - With a twin pregnancy there is a higher chance of one or both of your babies developing a congenital abnormality, a defect detected at birth. Because of this both fetuses are carefully screened with a detailed ultrasound at around week 20 of the pregnancy and if there are grounds for concern it may be suggested you have an amniocentesis to diagnose or rule out potential problems

• Miscarriage - Unfortunately the higher risk of congenital abnormalities also raises the chance of miscarriage, which is often nature's way of discontinuing a pregnancy that isn't healthy. Where miscarriage does occur you may lose only one of the babies, and this sometimes happens even before a mother is aware that she is pregnant with twins (vanishing twin syndrome). It is also possible that both babies may be lost, and the chances of that are higher for identical twins than for non-identical twins

• Polyhydramnios / excess amniotic fluid - Carrying more amniotic fluid than usual, polyhydramnios or hydramnios is more likely in multiple pregnancies and it can have a few implications for your pregnancy and birth.

• Sub-normal growth / growth discrepancies - With a twin pregnancy it is usual that both your babies will be smaller than an average single pregnancy baby. It is also more likely that one, other or both will have a low birth weight and it's not unusual for one baby to be significantly smaller than the other

• Premature birth - Low birth weight is more likely if your babies are born prematurely, and there is a higher likelihood of this with twin pregnancies. A single pregnancy lasts on average for 40 weeks whereas the average length of a twin pregnancy is 37 weeks. It's important to remember that a baby born at 37 weeks is considered at term, and not premature, but given the difference in averages, you do have a significantly higher chance of going into premature labour with twins: up to half of twins come early. This is something that medical teams are prepared for: You will be closely monitored for warning signs of early labour so that preventative measures can be taken and so you get the best possible care if your babies do arrive early

• Placental abruption - There is a higher risk of developing placental abruption (where the placenta detaches from the uterine wall ahead of birth) in twin pregnancies, but the risks are extremely low for healthy mothers - factors such as maternal malnutrition and smoking play a far more significant role increasing the likelihood of the condition

Managing the risks
Ensuring you have a healthy, balanced diet can help you deal with many of the discomforts that are common during pregnancy, if you do experience pregnancy discomforts then the usual advice applies just as much to twin pregnancies.

When it comes to complications in pregnancy it can help to be aware of the warning signs that indicate there may be a problem, and to raise any concerns with your doctor. Try not to worry about the possibilities and risks though, for most complications (except early labour) the risks are still very low and it's a fact that most twins are born healthy. Be reassured that your doctor will tailor your antenatal care to your particular circumstances and try to relax and enjoy your pregnancy.

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