How to have a healthy pregnancy carrying twins


Pregnant with twins? Here's great advice to keep you and your twins healthy, from Dr. Keith Eddleman, head of Obstetrics at Mt. Sinai Hospital in New York.

How to have a healthy pregnancy carrying twins

Multiple births are more common today than ever before. The extra care for twins or even triplets has to start early when you are pregnant. Here are some tips on how to do just that.

  • At your first pre-natal visit you should be able to determine if you’re having twins.
  • Being aware of your nutrition is even more important when having twins. You should consume 600 extra calories a day if you are carrying twins.
  • More nutrients like iron and folic acid are also very important. 
  • You also should gain more weight with twins, approximately 35-45 pounds.
Risks of carrying multiples
  • There are some risks you should be aware of if you are carrying twins, triplets or more.
  • There is a higher risk of premature delivery with twins.
  • There is also a higher risk of developing a blood pressure disorder.
  • Carrying twins or more can also result in developing gestational diabetes, a temporary form of diabetes.
  • There is also a risk of developing growth restriction where one or more of the babies are not growing well.
  • Some of these risks can be monitored by your doctor with ultrasounds but with others, like pre-term labor, you need to be aware of the symptoms.
  • It is important to go for regular ultrasounds with twins to make sure both babies are getting the proper nutrients since they are competing in the womb.
Risk factors with different types of twins
  • Dichorionic twins, the most common, means that they have two separate placentas.
  • Monochorionic twins are less common and they share one placenta. There are more complications, such as nutrients not being properly distributed, associated with monochorionic twins.
  • It is important for your doctor to determine between dichorionic and monochorionic twins so you are aware of any complications that may arise.

LISA: I'm Lisa Birnbach for It's a boy! It's a girl! It's a boy and a girl! It's twins or maybe even triplets. Multiple births are more common today than ever before and the extra care for these babies has to start early when you're pregnant. Joining us is Dr. Keith Eddleman, director of Obstetrics at Mount Sinai Hospital in New York and author of two books on pregnancy including Pregnancy for Dummies. Dr. Eddleman thanks for being here.

DR. EDDLEMAN: Thanks for having me. 

LISA: Let's walk parents through the pregnancy process of twins. You would probably know you're carrying more than one fetus at your first ultrasound right?  Or before?

DR. EDDLEMAN:  Well in this day and age most people have an ultrasound at the early first prenatal visit and it should be identifiable then, but we still find patients that don't know until they get to be 20 weeks. So, I'd say most people know early on, but not everybody. 

LISA: Do you need to watch your nutrition even more when you're carrying twins than when you're carrying a singleton? 

DR. EDDLEMAN:  Absolutely. You need to consume about 600 extra calories a day. With a singleton it's 300. So with twins it's 600 extra calories. And with the singleton the recommended weight gain is around 25 to 30 pounds total. With twins it's really 35 to 45. So you definitely need to gain more weight and be conscious that you need extra, not only calories, but also nutrients like iron and folic acid.

LISA: What else do you need to do if you're carrying twins to protect yourself and to protect your twins? 

DR. EDDLEMAN:  Well you need to be aware of the risks of twins really. And the risks of twins, and triplets and more, are, compared to singletons--you have a higher premature risk in delivery. You have a higher risk of developing preeclampsia or toxemia which is a blood pressure disorder with pregnancy and a higher risk of developing gestational diabetes, a temporary diabetes during pregnancy. And then finally a higher risk of something called growth restriction where the baby's just not growing well. So you need to be aware of those increased risks. Some of them your doctor can watch out for with ultrasounds, but some of them like pre-term labor--you need to be aware of the symptoms, so that you can identify it early and hopefully intervene. And your doctor will go over the symptoms of that with you early during the pregnancy so you can watch out for them. 

LISA: Dr. Eddleman is there a difference between two babies born out of one placenta or two babies born out of two placentas? 

DR. EDDLEMAN:  There is and that's one of the most important things your doctor needs to determine very, very early on. The most common is something called dichorionic twins which means they have two separate placentas, totally separate. The less frequent occurance is something called monochorionic twins and they share one placenta. And there are a host of different complications that can occur in the setting of monochorionic twins. So, it's important to know that so that your doctor can discuss those issues so that you can map out a strategy and look for them and deal with them during the pregnancy if they occur. 

LISA: Dr. Eddleman, physically what can a mom expect when she is carrying twins that will make her pregnancy somewhat different than someone carrying one? 

DR. EDDLEMAN: First of all women have a higher rate of feeling nauseous or having nausea and vomiting in the first trimester and that's actually correlated with the number of babies. More increased in twins, even more so in triplets and it's pretty much the rule with quadruplets. 

LISA: And morning sickness doesn't only happen in the morning.

DR. EDDLEMAN:   We know that. Morning sickness is really any time of day sickness. The other things--your body is growing at a more rapid rate and the changes that occur with a normal pregnancy is pretty significant already--are occurring even more rapidly with twins. Your body grows faster, your center of gravity shifts differently. You tend to become more uncomfortable because of your sheer size. You're carrying around, you know, two babies and you just get more tired, especially in the second or third trimester from the sheer weight that you're carrying around. 

LISA: Growth restriction: is there a point at which a twin can't get bigger because there's no room in there?

DR. EDDLEMAN:   Well there is the concept of crowding, you know, crowding--and also the babies are competing for nutrients. And for that reason we recommend that women with twins go for periodic ultrasounds to make sure that they're both growing equally and that they're not competing because when you have a situation where one baby's growing more than the other, you need to watch those more carefully because they're at an increased risk for something happening while they're inside the uterus. 

LISA: So there's nothing you can do to change that.

DR. EDDLEMAN:   There's really not much you can do to change it, but you can increase the level of surveillance and testing so that you can--if you need to bail out early you can do that to avoid something that's catastrophic.

LISA: Thank you so much for being with us Dr. Eddleman.

DR. EDDLEMAN:   Thanks for having me.

LISA: For I'm Lisa Birnbach. 

meet theexpert
  • Dr. Keith Eddleman

    Dr. Keith Eddleman Director of Obstetrics, Mount Sinai Hospital, New York Dr. Keith Eddleman is Director of Obstetrics at Mt. Sinai Hospital in New York City. He practices Clinical Genetics, Maternal & Fetal Medicine, and Obstetrics and Gynecology. Dr. Eddleman is the author of two books on pregnancy. more about this expert »

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