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A multiple pregnancy is when you are pregnant with twins, triplets or more. Three babies or more is called a ‘higher order’ pregnancy, and it’s rare – occurring in just 1 in 50 multiple pregnancies. Find out more about the different types of multiple pregnancy here.
How do multiple pregnancies occur?
Multiple pregnancies occur when more than one embryo implants in your uterus (womb). This can happen if you release more than one egg during the menstrual cycle and each egg is fertilised by a sperm. Sometimes, a fertilised egg spontaneously splits into 2, resulting in identical embryos.
Multiple pregnancies are more common than they used to be, mainly because of the increasing use of in vitro fertilisation (IVF).
Fertility drugs often cause more than one egg to be released from the ovaries. IVF can result in a multiple pregnancy if more than one fertilised embryo is transferred to the uterus and develops. Sometimes, one of these eggs may split into twins after it is transferred.
Women aged 35 and older are more likely to release more than one egg during ovulation, so they are more likely to have a multiple pregnancy. You are also more likely to have a multiple pregnancy if you have a history of twins in your family.
Diagnosis of multiple pregnancy
Signs you may be expecting multiple babies include:
- You gain weight rapidly at the start of the pregnancy.
- You have severe morning sickness.
- More than one heartbeat is picked up during a prenatal examination.
- The uterus is larger than expected.
A multiple pregnancy is confirmed by an ultrasound scan, usually in the first trimester (the first 12 weeks). The ultrasound will confirm the type of multiple pregnancy, whether there is one placenta or 2, and how many amniotic sacs there are. These are all important factors for later in the pregnancy and it’s important to identify them as early as possible.
If you are carrying multiple babies, you will have to see your doctor more often than women who are expecting one baby. While most multiple pregnancies progress smoothly, there’s a higher chance of the babies being born prematurely, having a low birth weight, or for you to have other complications with your pregnancy.
Types of multiple pregnancy
The most common type of multiples are:
Fraternal twins
Two separate eggs are fertilised and implant in the uterus. The babies are siblings who share the same uterus — they may look similar or different, and may either be the same gender (2 girls or 2 boys) or of different genders. A pregnancy with fraternal twins is statistically the lowest risk of all multiple pregnancies since each baby has its own placenta and amniotic sac. You will sometimes hear fraternal twins referred to as ‘dizygotic’ twins, referring to 2 zygotes (fertilised eggs).
Identical twins
Identical twins are formed when a single fertilised egg is split in half. Each half (embryo) is genetically identical, so the babies share the same DNA. That means the babies will share many characteristics. However, because their appearance is influenced by the environment as well as by genes, sometimes identical twins can look quite different. Identical twins may share the same placenta and amniotic sac, or they may have their own placenta and amniotic sac. You will sometimes hear identical twins referred to as ‘monozygotic’, referring to one zygote (fertilised egg).
Triplets and ‘higher order multiples’ (HOMs)
Triplets, quadruplets, quintuplets, sextuplets or more can be a combination both of identical and fraternal multiples. For example, triplets can be either fraternal (trizygotic), forming from 3 individual eggs that are fertilised and implanted in the uterus; or they can be identical, when one egg divides into 3 embryos; or they can be a combination of both.
If you are having 3 babies or more, you will need a lot of support throughout your pregnancy.
Are identical twins or triplets always the same sex?
Because identical twins or triplets share genetic material, they are always the same sex. The sex of a baby is determined by the particular sperm cell that fertilizes the egg at conception. There are two kinds of sperm cells — those carrying an X chromosome or Y chromosome. The mother’s egg carries an X chromosome. If a sperm cell carrying an X chromosome fertilizes the egg, it will make a XX combination (female). If the sperm cell is carrying a Y chromosome, you end up with an XY pairing (male).
Identical multiples start as one egg and then split, so whatever chromosome combination is present at fertilization is the sex of all multiples.
What increases the chance of a multiple pregnancy?
There are several factors that can increase the risk of a multiple birth. You might be at a higher risk of getting pregnant with more than one baby at a time if you:
- Are older (women in their 30s are at a higher risk of multiples because the body starts to release multiple eggs at one time when you get older).
- Are a twin yourself or have twins in your family.
- Are using fertility drugs.
You might also be at a higher risk of a multiple pregnancy if you are taller than average or have a higher body weight.
Another risk factor for a multiple pregnancy is genetic. There is an increased possibility of a multiple pregnancy if you are a multiple yourself, or if multiples run in your family. This heredity trait is generally passed down through the maternal (mother’s) side of the family.
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The use of fertility drugs can be another reason you might have a multiple birth. Treatments for infertility can increase your risk of a multiple pregnancy because procedures, like in vitro fertilization (IVF), often involve transferring more than one fertilized egg into your womb. Your provider usually transfers more than one egg at a time to increase the odds of a successful pregnancy.
What are the signs of a multiple pregnancy?
The only way to know if you’re pregnant with more than one baby during your pregnancy is through an ultrasound exam with your healthcare provider. During this test, your provider can look at images of the inside of your uterus and confirm how many babies are in there.
You might experience more intense symptoms during a multiple pregnancy than with a single pregnancy. These can include:
- Severe nausea and vomiting (morning sickness).
- Rapid weight gain in the first trimester of pregnancy.
- Sore or very tender breasts.
- High human chorionic gonadotrophin (hCG) levels — this hormone is made during pregnancy and is what a pregnancy test picks up.
- High amounts of the protein alpha-fetoprotein in your blood.
Apart from an ultrasound, your provider might suspect multiples if there’s more than one heartbeat detected during a fetal Doppler scan.
What complications are linked to multiple births?
Anyone can experience complications during pregnancy — regardless of how many babies you’re carrying. However, most healthcare providers consider multiple pregnancies higher risk than single pregnancies. This doesn’t mean that every woman who carries more than one baby during a pregnancy is going to have problems. If you’re pregnant with multiples, your provider will want to watch you for possible complications that can happen when you carry more than one baby at once. Your provider will talk to you about each risk factor and frequently check with you to make sure you aren’t experiencing anything concerning.
Possible complications include:
- Premature labor and birth: The most common complication of multiple births is premature labor. If you’re pregnant for multiples, you are more likely to go into premature labor (before 37 weeks) than a woman carrying only one baby. The goal for many moms of multiples is to complete 37 weeks. This is considered term in a twin pregnancy and reaching this week of gestation increases the chance the babies will be born healthy and at a good weight. Babies that are born prematurely are at risk of another complication of multiple births — low birth weight.
- Preeclampsia or gestational hypertension (high blood pressure): High blood pressure is called hypertension. During pregnancy, your healthcare provider will watch your blood pressure carefully to make sure you don’t develop gestational hypertension (high blood pressure during pregnancy). This can lead to a dangerous condition called preeclampsia. Complications related to high blood pressure happen at twice the rate in women carrying multiples compared to women pregnant with only one baby. This complication also tends to happen earlier in pregnancy and be more severe in multiple pregnancies than single pregnancies.
- Gestational diabetes: You can develop diabetes during pregnancy. This happens because of the increased amount of hormones from the placenta. The size of the placenta can also be a factor in this condition. If you have two placentas, there’s an increased resistance to insulin.
- Placenta abruption: This condition happens when the placenta detaches (separates) from the wall of your uterus before delivery. This is an emergency situation. Placenta abruption is more common in women who are carrying multiples.
- Fetal growth restriction: This condition can also be called intrauterine growth restriction (IUGR) or small for gestational age (SGA). This condition happens when one or more of your babies is not growing at the proper rate. This condition might cause the babies to be born prematurely or at a low birth-weight. Nearly half of pregnancies with more than one baby have this problem.
Fraternal twins always have two placentas. The risks of pregnancies with fraternal twins are similar to those of pregnancies with only one baby. However, the number of possible risks are increased when compared to pregnancies with one baby.
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