Multiples Pregnancy


If you are pregnant with more than one baby – twins, triplets or more – it is known as a multiple pregnancy. Multiple pregnancies are considered higher risk because each additional fetus increases the possibility that complications may occur.

Pregnancies with multiples are more common in:

  • Older women (over the age of 30)
  • Women who have undergone fertility treatment
  • Women with a family history of multiples

Common Complications

Women pregnant with multiples face an increased risk of certain complications, including:

Preterm birth and low birth weight. Preterm birth, before 37 weeks, is the most common complication of a multiple pregnancy. According to the American College of Obstetricians and Gynecologists (ACOG), more than half of all twins are born preterm and “higher-order” multiples – triplets or more – are almost always preterm. Preterm babies are at increased risk of short- and long-term health issues, including breathing difficulties at birth, childhood learning disabilities, and cerebral palsy.

Preeclampsia, a high blood pressure disorder that develops during pregnancy, usually after 20 weeks. Preeclampsia occurs more often in multiple pregnancies. It also tends to occur earlier and with greater severity. Risks include reduced blood supply to the fetuses, problems with organ function in the mother, placental abruption (placenta detaches too early from the uterine wall), and preterm birth.

Gestational diabetes, or high blood sugar that develops during pregnancy. Untreated, diabetes can increase the risk of preeclampsia, breathing problems in newborns, and excessive fetal growth (babies are too large).

Fetal growth restriction. Multiple fetuses are more likely to have growth problems. One fetus may be significantly smaller than the other(s), a common occurrence in multiples known as discordant growth. Frequent ultrasound exams may be required to monitor the babies’ growth and determine the cause of the growth restriction. 

Need for a C-section. A multiple pregnancy is more likely to require a cesarean delivery, a major surgery with risks that include infection and blood loss.

What to Expect During Pregnancy with Multiples

  • Diagnosis through ultrasound. Pregnancies with multiples are confirmed – and often first discovered – through an ultrasound exam 
  • Specialized care from a maternal-fetal medicine physician, if needed. Your multiple pregnancy may require the expertise of a maternal-fetal medicine physician, a specialist in managing high-risk pregnancies and optimizing the health and safety of mothers and babies
  • More frequent prenatal visits compared to a single pregnancy, for closer monitoring
  • More frequent ultrasound exams to track fetal growth and development 
  • Prenatal testing for twin-to-twin transfusion syndrome (TTTS), a rare but serious complication in which twins share a placenta and the blood flow becomes unbalanced

Benefits of Specialized Care

Here at Texas Children’s Pavilion for Women, our maternal-fetal medicine specialists are highly trained and experienced in the treatment of complex, high-risk pregnancies, including multiple pregnancies.

We offer you and your babies: