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6 Risks of Multiple Births & How is the Pregnancy with Multiple Births Managed?

While the basics of pregnancy are the same, multiple births do come with their unique risks and an ultra large belly. Here’s what you should know about multiple births.

6 Risks of Multiple Births

What are the Types of Multiple Births?

When talking of multiple births, one most commonly thinks of is twins. Compared to larger number of multiple births, twins are by far the most common. Twins can be either identical or fraternal. Although rarely, cases of higher-order multiples (HOMs), like triplets and quadruplets, can also happen. There are several different ways in which multiple births can be arranged. While singletons have a single placenta and only one amniotic sac, multiple fetuses on the other hand may share either or both of those. This arrangement can get a bit more complicated with triplets and HOMs. The birth of conjoined twins is the rarest phenomenon. Fewer than 25% of cases of conjoined twins survive.

What are the Risks Linked to Multiple Births?

With all the growth and development happening inside a woman’s body, pregnancy is already a highly complicated phenomenon, and when two or more little ones develop at the same time, the complications tend to further increase. Higher the number of multiple fetuses, the greater the risks involved. Some such risks of multiple births are:

Preterm Birth

Premature birth is the most common complication that occurs in multiple births. This complication arises because of preterm premature rupture of the membranes or PPROM. Single pregnancies last for an average of 39 weeks while twin pregnancy last an average duration of 36 weeks. The average duration for triplets is 32 weeks while for quads and quints, it is 30 and 29 weeks, respectively. The full term for multiple birth pregnancy is considered to be 40 weeks. The earlier the birth, the greater is the risk of occurrence of serious complications. The hearts and lungs of preterm babies in multiple births may not have developed fully and so they may need ventilator support or other medical intervention at the time of birth.

Low Birth Weight of the Babies

Multiple births are characterized with higher risk of low birth weight. The growth of babies in case of multiple births is slowed down because the blood flow from the placenta is not strong enough in such cases. Infants with a low birth weight are known as SGA or small for gestational age. These babies face a higher chance of suffering from complications like hypothermia, meconium aspiration and asphyxia at the time of and post delivery. These can result in long-term medical conditions like cerebral palsy.

Pre-Eclampsia in Mothers

Compared to females with singletons, women with multiple births are 3 times more likely to develop the life-threatening medical condition called pre-eclampsia or pregnancy-induced high blood pressure. This health condition can cause damage to the mother’s brain and other organs and raise the risk of complications during delivery. One of the most serious risks connected to preeclampsia is placental abruption, wherein the placenta detaches or separates from the wall of the uterus before time.

Twin-Twin Transfusion Syndrome

Twin-twin transfusion syndrome is a condition where one baby gets more blood flow than the other. The risk of occurrence of this condition is greater in case of multiple births, which have monochorionic twins or those which share the same placenta. Twin-twin transfusion syndrome can be fatal for one or both the children. Preterm birth is more common in cases of babies suffering from twin-twin transfusion syndrome. This condition affects around 15% of identical twins and pregnant women must contact their doctor immediately if they experience a sudden growth in their uterus or if their belly is unusually large for their stage of pregnancy.


Multiple births are more likely to need a c-section for delivery, especially in case of triplets and HOMs, as these babies are more premature and are less able to tolerate the stress of labor and delivery. Babies which are a part of multiple births need immediate medical support at their time of birth.

Birth Defects in Babies

Compared to singletons, multiple births are more often premature and are thus twice more likely to suffer from birth defects. The babies of multiple births generally have low birth weight and deprivations related to twin-twin transfusion syndrome, and so do not develop normally due to the lack of proper nutrition.

What are the Factors which Increase the Risk for Multiple Births?

Certain risk factors which increase the possibility of multiple births are:

  • A diet rich in fats.
  • A family history of multiple births, especially in the individual’s maternal family.
  • Age and number of children one has had before. Women older than 35 years who have already had 4 children are 3 times more likely to have multiple births compared to a childless women aged less than 20 years.
  • Use of IVF or other fertility treatments. One-third of women who have undergone these fertility treatments are likely to give multiples births.

Multiple births have increased significantly over time. The rate of multiple births have spiked up by around 75% since 1980. This is mainly due to the rise of fertility treatments and the increasing average age at which women have babies. With the improvement and advancement of fertility treatments, multiple births related to those treatments are; however, becoming less common.

How are Multiple Births Detected? How is the Pregnancy with Multiple Births Managed?

It is generally within the first trimester that the doctor determines that a woman is pregnant with multiple births such as twins or HOMs. Depending on the woman’s family history, health, and the number of babies, amniotic sacs and placentas, some extra checkups may be required. Women carrying more than a single fetus must stay in close contact of their doctors, report any unusual symptoms and must take extra care of themselves. The doctor may also advice extra nutritional supplements, a healthy dietary regime and a special exercise program, which is considered safe and beneficial for such pregnancies. As the due date approaches, the women having multiple babies may need bed rest to help extend their pregnancy for as long as possible. Additional monitoring may be required in cases of multiples conceived with IVF, as they face a greater risk of complications compared to their naturally conceived counterparts.


Although news of multiples may be very exciting for you, but it also calls for tender self-care on your part. Multiple births imply that you’ll have your hands full, and so to manage this situation better, it’s best to seek support from family and friends.


  1. American College of Obstetricians and Gynecologists: https://www.acog.org/
  2. March of Dimes: https://www.marchofdimes.org/
  3. MedlinePlus: https://medlineplus.gov/

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 2, 2023

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