Multiple Pregnancy Care

A multiple pregnancy is a term used to describe a pregnancy where a woman is pregnant with more than one baby, such as twins or triplets. Pregnancies which result in more than three babies are termed a ‘higher order multiple’ (HOM).

 Types of multiple pregnancies

The two most common types of multiple pregnancies include:

  • Identical twins – occurs when one egg is fertilised by one sperm, and the fertilised egg splits into two. The babies will share the same DNA and will be the same sex.
  • Fraternal twins – occurs when two eggs are fertilised by two sperm. The babies will have their own DNA, and their own amniotic sac and placenta. They can be the same or different sex.
  • Triplets or ‘higher order multiples’ (i.e. quadruplets, quintuplets, etc) can be a combination of identical or fraternal multiples. However, these are very rare.

Early pregnancy care

Early in pregnancy, an ultrasound scan should be done to determine the age and number of babies, as well as the chorionicity (the number of outer membranes and associated placenta) and amnionicity (the number of amniotic sacs).

Babies who share a placenta can have increased risks for complications compared to babies who have their own placenta.

Antenatal visits

Antenatal visits with Dr Hong during your pregnancy will be similar to that of a singleton pregnancy (see general pregnancy care) except that you will need more antenatal visits to help monitor your pregnancy more closely.

You will also require more scans, particularly in the second stage of your pregnancy to monitor the growth and development of your babies.

Based on the type of multiple pregnancy you have, an individual care plan will be tailored to you and the needs of your babies through each antenatal visit.

Additional support for a multiple pregnancy is also available through:

  • Multiple Birth Association – https://www.amba.org.au/
  • Antenatal classes for a multiple pregnancy – speak with Dr Hong to see if there are classes that are local to you.

Nutrition

Your nutritional requirements during a multiple pregnancy will be higher for some nutrients compared to that of a singleton pregnancy. For some women, Dr Hong may recommend speaking with a registered dietician for nutritional advice which can be helpful.

Additional nutrients you may require in a multiple pregnancy:

  • Folic acid – there is an increased risk for folate deficiency in a multiple pregnancy.
  • Iron – there is an increased risk for folate deficiency in a multiple pregnancy. A routine iron supplement is generally recommended, however routine testing to screen for iron deficiency will be done during your antenatal course.

Energy requirements

There is limited data available to date regarding energy requirements in a multiple pregnancy, however energy needs are greater than that of a singleton pregnancy. Data from weight gain in twin pregnancies suggest the following recommendations:

  • First trimester – no additional calories required.
  • Second trimester – approximately 490 calories/ day additional to normal requirements.
  • Third trimester – approximately 600 calories/ day additional to normal requirements.

The best measure of calorie intake during your pregnancy is to monitor your pregnancy weight gain.

Pre Pregnancy BMIClassificationWeight Gain recommendation  (kg)
18.5 – 24.9Normal17 – 25
25 – 29.9Overweight14 – 23
≥30Obese11 – 19

Provisional gestation weight gain in a multiple pregnancy

Self-care in Pregnancy

Your health and wellbeing prior to and during your pregnancy has a direct impact on the health and wellbeing of your babies.

Pregnancy care measures that you can start straight away to ensure optimal health for you and your babies include:

  • Avoiding all alcohol, smoking and substances (such as illegal drugs), which pose a serious health threat to you and your babies.
  • Ensure you are consuming a healthy and balanced diet. Speak to your GP or Dr Hong to obtain a referral to a registered dietician to discuss optimal nutrition in a multiple pregnancy.
  • Check with your GP or Dr Hong regarding your vaccination status, as well as additional vaccines, which are relevant in pregnancy such as flu and whooping cough vaccines.
  • As soon as you start to plan your pregnancy it is important to take a folic acid supplement to help prevent birth defects such as spina bifida.

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