Multiple Gestation

Our society is intrigued with the idea of multiple gestation. Although twins and triplets rarely evoke much excitement in a time when quads, quints and even sextuplets seem commonplace, the world loves the thought of siblings who share the same birthday. Thanks to “advancements” in infertility management, the world gets a periodic glimpse at what appears to be a wonder of the natural world……fueled by the talking heads of the nightly news and entertainment programs.

The professional obstetrical community feels otherwise. Doctors and midwives understand the true risks of multiple gestation. The risks for poor outcomes compound dramatically for each additional fetus. Multiple gestation is justifiably considered a serious complication of pregnancy. Atlhough most twins and triplets born in Level II and III centers do well, the costs are potentially astronomical. The very serious risks of prematurity in multiple gestation justify serious consideration before one uses the fertility drugs which are now responsible for most of these pregnancies.

The female human body is essentially designed for one fetus at a time. Two can be accomodated, but not without significant increases in the risks of premature birth, diabetes, hypertensive disorders and growth retardation. More than three fetuses almost guarantees some morbidity and pushes health care costs beyond most families’ ability to pay.


Average Gestational Age
Average birth weight
Perinatal Mortality*

40 weeks
3400 grams

2700 grams


1900 grams

*Perinatal mortality is the number of fetal (usually 20 weeks of gestation or more) and neonatal deaths (first 28 days of life) per 1,000 live births.

If you are carrying more than one baby, expect a pregnancy during which many of the common discomforts and problems are exaggerated. The need for frequent, intensive prenatal care is your best bet for optimal outcomes. Your nutritional requirements also increase, and you should consult a dietician early in pregnancy. You will need an iron supplement.

One of the most significant risks of multiple gestation pregnancies is the risk of premature labor and birth (see Preterm Labor). You should be a part of a Preterm Birth Prevention program at your hospital, and have immediate access to a Level III nursery if you go into labor prior to the 35th week. You may even need to have a electronic uterine contraction monitor (a tocodynamometer, or toco) at home, which you would use daily in the 24-35 gestation week period.

From the middle of your pregnancy until you give birth you will probably need additional assistance at home. Since the risk of premature birth is very high, you may need to have someone care for both you and your household if (when) you need to decrease your physical activity or are placed on bedrest. You will probably experience more (and earlier) body changes and the common discomforts of pregnancy are exaggerated with multiple gestation.