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| |     Medical Implications of a Twin Pregnancy by Elisa Ross, MD reviewed and revised by Marjorie Greenfield, M.D. Every pregnancy has its share of changes and discomforts, such as nausea and fatigue. But if you're carrying two babies, some of these changes can be doubly difficult. Don't let that worry you, though--most mothers of twins make it through their pregnancy just fine. That said, it's more important than ever to take good care of your body nutrition-wise. Experts suggest adding to your daily diet an estimated 300 calories per baby. Make sure to take your regular prenatal vitamin and consider taking an extra folic acid supplement each day. (However, don't double up on the prenatal vitamins; it might end up delivering a high and potentially harmful dose of certain vitamins.) Because the babies use a lot of iron to make their blood cells, extra iron supplementation will be helpful in the second half of the pregnancy. Does your back ache just thinking about carrying around two babies? Well, do yourself a favor and don't let your weight skyrocket out of control. Most healthcare providers recommend gaining between 30 and 50 pounds for the entire pregnancy. (It's worth noting, though, that the relationship between the mother's weight gain and the babies' well-being is inexact, and perfectly healthy babies have been born to mothers whose weight fell outside of these guidelines.) Unfortunately, being pregnant with twins leaves you more vulnerable to a few medical conditions, but they're easy enough to recognize and your practitioner will watch for them throughout your pregnancy. Most mothers-to-be of twins don't experience these complications; nevertheless you'll probably have to see your healthcare provider more often and undergo more frequent ultrasounds, just to be on the safe side. Preterm labor Since two babies stretch out a uterus sooner than one, a chance exists that your twins will be born early. In the third trimester, your practitioner probably will check your cervix frequently--either by exam or with ultrasound--to watch for signs of preterm delivery. Some doctors choose instead to rely on the mother's report of contractions. You might have to curtail your activity toward the end of your pregnancy and spend more time lying down, so be sure to discuss your limitations with your practitioner. High blood pressure Pre-eclampsia or pregnancy induced hypertension is seen more often in twin pregnancies; however, the diagnosis and treatment is the same as when carrying a single baby. Gestational diabetes The placenta produces the anti-insulin hormone responsible for gestational diabetes. Because a greater amount of placenta is present in twin pregnancies, the risk of developing this condition is greater (though still small). Growth restriction Since twins have to share the nutrition they receive, one or both babies might grow at a slower rate than expected. Ultrasounds are generally performed in the last few months of pregnancy in order to follow the growth of each twin. Twin-twin transfusion syndrome This rare but serious condition happens when the blood vessels from one placenta become connected to the other. The result: One twin gets more than his share of blood flow, and the other gets less. Only identical twins are at risk for twin-twin transfusion syndrome. Ultrasound helps monitor the condition, and a maternal-fetal specialist (perinatologist) is needed to manage it. For more information about twin-twin transfusion syndrome, see www.tttsfoundation.org. Birth defects Sadly, twins run a slightly higher risk of birth defects or genetic problems. For more specifics, talk to your practitioner or a maternal-fetal specialist. Miscarriage of one twin Sometimes one twin will miscarry, leaving the other to develop on its own. If this happens early in the first trimester, bleeding and the passage of tissue may occur or the mother's body may simply absorb it. A miscarriage that takes place later than three or four months' gestation requires close observation, usually by a specialist. More information: Talk about:
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