Multiple Gestation - Causes, Risk Factors, Complications and Prevention

What Are Multiple Pregnancies?

Multiple pregnancies are pregnancies with two or more babies at a time. Multiple pregnancies make up about three in 100 births, and nowadays, the rate of multiple pregnancies is rising. If a mother is caring for two babies, they are called twins; three babies are called triplets, four babies are called quadruplets, five babies are called quintuplets, and six babies are called sextuplets. The risk associated with multiple pregnancies is more when compared with a single pregnancy. It is called higher-order pregnancy when there are more than three babies, and it is rare to occur.

What Are the Causes of Multiple Pregnancies?

There are two different types of multiple pregnancies that result in either fraternal siblings or identical twins.

Fraternal Siblings:Fraternal multiples occur from separate eggs fertilized by a different sperm. This can happen if the body releases multiple eggs and more than one egg is fertilized. Boys, girls, or both can be produced during this pregnancy. The genetic material is varied because of different eggs and different sperm. However, they look very similar and have separate placenta and amniotic sacs.

Identical twins:In this case, one egg is fertilized and then divided into two or more embryos. These embryos are identical and genetically same and share a placenta with a different sac. Some cases may also have a placenta with the same sac. They may have all boys or all girls.

Multiple pregnancies are more common because of the increasing use of in vitro fertilization (IVF). Due to fertility drugs, ovaries release more than one egg. This can result in multiple pregnancies occurring in IVF if more than one fertilized embryo is moved to the uterus and develops.

There are cases with both identical and fraternal multiples; when more than one egg is fertilized, at least one of those eggs splits after fertilization.

What Are the Risk Factors For Multiple Pregnancies?

Many factors are said to cause multiple pregnancies, that include:

• Family History - A family history of having multiple pregnancies leads to increased chances of having multiple pregnancies. This heredity trait is normally passed down through the mother’s family side.

• Older Age - Women older than 35 have a high chance of multiple pregnancies because their body begins to release multiple eggs at one time when women get older, thus increasing the chances of multiple pregnancies.

• Race - African-American women have more chances of having twins than any other race. Native Americans and Asians have the lowest chance of having twins. White women, especially those older than 35, have an increased rate of triplets or more births (higher-order pregnancy).

• Medicines That Stimulate Ovulation - Drugs like follicle-stimulating hormone (FSH) and Clomiphene citrate are medicines that stimulate ovulation and help in producing many eggs causing multiple babies.

• Assisted Reproductive Technologies - In vitro fertilization (IVF) and other technologies often use medicines that stimulate ovulation to produce multiple eggs. These eggs are fertilized in the lab and inserted into the uterus to grow.

What Are the Complications Caused by Multiple Pregnancies?

As the number of babies increases, so do the complications. So there should be extra care required. The doctors will discuss each risk factor and frequent checkups to ensure the baby and mother are safe and out of complications.

Complications In Mothers:

Anemia -Multiple pregnancies have a high risk of developing anemia. Doctors and nutritionists will advise having a healthy and balanced diet with vitamin and folic acid supplements during pregnancy. A blood test will be taken to check for anemia at 20 to 24 weeks and 28 weeks of pregnancy.

Increased Pregnancy Symptoms - Pregnant women will experience intense pregnancy symptoms with multiple pregnancies because of the increased pregnancy hormones. So pregnant women may experience severe morning sickness, persistent heartburn, and increased breast tenderness. As the pregnancy progresses, swelling in the ankles, varicose veins, shortness of breath, back pain, and pelvic pain can develop.

Preeclampsia -Preeclampsia is a dangerous condition; it combines increased blood pressure (hypertension) and raised protein in the urine (proteinuria). This complication occurs earlier in pregnancy and is more severe in multiple pregnancies than in single pregnancies. Doctors advise taking low-dose aspirin from 12 weeks of pregnancy to reduce the risk of preeclampsia.

Gestational Diabetes - High blood sugar happens due to the increased hormones from the placenta. The size of the placenta can also play a role in this condition. So, having two placentas increases insulin resistance.

Placental Abruption -This condition occurs when the placenta separates from the uterus wall before delivery. This is a serious situation and is more common in women carrying multiples.

Intrahepatic cholestasis of pregnancy (ICP)-It is a severe liver condition that causes itching without any rashes. It is common during multiple pregnancies.

Complications For Babies:

Premature Birth -This is the most common complication of multiple pregnancies. This happens in 60 percent of twin pregnancies and 75 percent of triplet pregnancies. Women with multiple pregnancies are more likely to go into premature labor than a woman carrying a single baby. In addition, prematurely born babies have a high risk of other complications like low birth weight. Therefore, medications like corticosteroids will be given during the pregnancy to help the baby’s lungs develop more quickly to reduce the risk of complications associated with premature birth.

Fetal Growth Restriction- This condition is also called small for gestational age (SGA) or intrauterine growth restriction (IUGR). This condition happens when one or more babies are not growing at the proper rate, which leads to low birth weight or premature birth. Around half of the pregnancies with multiple babies have this problem.

Twin-To-Twin Transfusion Syndrome (TTTS)- This is a condition that occurs with identical twins who share the same placenta and also share the same blood vessels, causing imbalance in the blood supply. It happens in about 15 percent of twins with a shared placenta.

Twin-Anemia-Polycythemia Sequence (TAPS) - This occurs when blood flows from one twin to the other twin due to vascular communications at the placental level that makes one baby become anemic (low red blood cells). The other baby becomes polycythemic (too many red blood cells).

How to Prevent Complications During Multiple Pregnancies?

Complications can be limited by following good prenatal care:

• Increased Nutrition - Women carrying two or more fetuses need more calories, protein, calcium, and other nutrients, including folic acid.

• Frequent Prenatal Visits - Multiple pregnancies have increased risk, so more frequent visits may help the doctor find complications early and provide appropriate care.

• Good Rest - Some women may need bed rest to prevent preterm birth in multiple pregnancies.

• Tocolytic Medicines - Tocolytic drugs help slow or stop the contractions in premature labor. These drugs might be given orally, by injection, or intravenously.

• Corticosteroid Medicines - These medicines help to mature the lungs of fetuses. Lung immaturity is a significant problem for premature babies.

Conclusion:

Multiple pregnancies are primarily associated with complications. So understanding the difficulties and taking proper care is essential. In addition, a good nutritious diet, keeping hydrated, and frequent prenatal checkups will be helpful to prevent complications during delivery.