Being pregnant with more than one baby is exciting and is often a joyous moment for many couples. Then again, such situations require extra care for the expecting mother.

For starters, these women are offered more antenatal
appointments than a woman expecting one baby. 

It is, hence, important that young parents
understand the various aspects of the situation and prepare themselves to cope
with the changes in their lives.

17 facts to remember
about multiple pregnancies

Here are a few prenatal care guidelines for women who are pregnant with multiple babies:

  1. Antenatal visits

The best way to assure the
mother of a problem-free pregnancy is to attend all her antenatal
appointments. This could help detect and treat complications
that are likely to arise during the gestational period. The frequency of the visits
may be determined based on the status of her health and the condition of the fetus.
Ask the doctor about the ‘signs’ that one has to be aware of. This information
could help the woman be vigilant between her routine appointments.

Doctors provide information as well as
emotional support that are specific to cases, in which the mother has conceived
more than one child. They also grant the parents opportunities for further
discussions about other topics including:

  1. Antenatal
    as well as postnatal health
  2. Antenatal
    nutrition risks
  3. Symptoms
    and signs of preterm child-birth
  4. Details
    about the delivery
  5. Breastfeeding

An experienced obstetrician plays a crucialrole during the pregnancy. Since these are high-risk cases, multiplepregnancies are usually referred to hospitals with advanced facilities andservices

2. Diet,lifestyle, and nutritional supplements

One must take care with regards to the dietary pattern that has to be followed during this period. The diet should ensure adequate quantum of calories, proteins, fats, vitamins including folic acid, minerals and fluids. It is wise to have a light yet frequent diet plan as opposed to ‘stuffing’your stomach.

For instance, the recommended calorie requirement for a mother
expecting twins is 1800 calories. She needs extra energy (calories) to meet the
needs of her growing babies. Nourishing drinks and extra snacks, apart from the
regular breakfast, lunch and dinner, will help her immensely.

is essential for the development of red blood cells for the mother and her
babies. Women carrying twins or triplets are at a greater risk of becoming anaemic than those who go through singleton
pregnancies. Hence, they experience
fatigue, shortness of breath and leg cramps at night.

chicken and fish are the best sources of iron. Legumes/pulses, lentils, nuts,
wholegrain cereals and green leafy vegetables like drumstick leaves and spinach
also contain the mineral. Then again, iron
from these food items is not absorbed as
easily by the body, unlike the ‘non-vegetarian’

if the mother is a ‘strict-vegetarian’ the diet could also include food items
are rich in Vitamin C. This would help increase the iron intake of her body. Some of the sources of Vitamin
C include lemons, oranges, berries, kiwifruit, cabbage, broccoli, cauliflower, brussels
sprouts, capsicums and tomato. Some women, who are weak, are also encouraged to have iron supplements.

Extra calcium is needed to ensure the healthy development of the bones and teeth of the woman as well as her babies. Dairy productslike milk, yoghurt, cheese and tinned fish with edible bones like salmon orsardines are excellent sources of calcium. Many commercially available items, likesoy milk, have been fortified with calcium. Almonds and green leafy vegetables arealso excellent sources.

Iodineis another nutrient essential for the development of the brain and nerves. The sources of iodine include seafood, dairy products, iodine-enriched bread, and iodized salt. If you have been diagnosed with a thyroid condition, you should talk to their doctor before taking any supplements.

Most importantly, the woman must discuss, with her doctor, about the choices of physical activities. Some women may need to limit their physical activities duringa later stage of their pregnancy. These include travel and work. Many womenpregnant expecting more than one-baby are advised bed-rest as well (i.e eitherimply staying in bed all day (complete bed rest) or resting a few times eachday).

  • The well-being of the mother and baby

At each prenatal visit, the
doctor will review the woman’s health status. She may be asked about minor
ailments and signs of pregnancy complications. Usually,
a clinical examination is conducted to assess the growth of the baby in the utero. The woman may also be advised to undergo
specific tests including serial ultrasonography
(nuchal translucency, fetal growth, placental blood flow and chorionicity) and blood tests
(beta-human chorionic gonadotrophin,
pregnancy-associated plasma protein-A) to detect any deviations from the normal
development. In the later weeks of the pregnancy, a non-stress test (assessment
of  fetal cardiac activity in response to
fetal movements) is conducted. During labor, cardio-tocography (assessment of
fetal heart response to uterine contractions ) is performed to detect any fetal

Maternal weight gain and hemoglobin levels are also checked during prenatal visits. Expertssay that women who have a normal body mass index and are carrying twins, shouldgain between 17 -25 kilograms (kg). Those who are overweight should gain 14-23kg and obese women should gain 11-19 kg. 

Screening offered in multiple pregnancies

The doctor is responsible for providing information and counselling before as well as after every
screening test. The woman may be advised to
undergo ultrasound scans, if she pregnant with twins and triplets at a later
gestational age. These scans will also take longer to perform.

tests and ultrasonography may be used to detect any signs of Down's syndrome, structural
abnormalities, feto-fetal transfusion syndrome and intrauterine growth

[… to be continued..]

Twin, triplets or more: Understanding multiple pregnancies – Part 1
Article Name
Twin, triplets or more: Understanding multiple pregnancies – Part 1
Here are a few prenatal care guidelines for women who are pregnant with multiple babies
Published By

This article has been written by Dr. Namitha Subrahmanyam. She has been working as a nurse for over 13 years and holds an M.Sc in OBG Nursing. Recently, Namitha Subrahmanyam has been awarded a PhD. She is also working as an Associate Professor at the Department of Obstetrical and Gynaecological Nursing of the MOSC College of Nursing, Kochi, Kerala, India.