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Health Risks with A Multiple Pregnancy

A multiple pregnancy means you’re pregnant with 2 or more babies. Most people who are pregnant with 2 or more babies can have a healthy pregnancy. But the risk of complications is higher than with 1 baby. If you are pregnant with 2 or more babies, you need to know the warning signs of possible problems. If problems do happen, work closely with your healthcare provider. This can help you stay healthy and deliver healthy babies. Below are some complications that are more likely in any type of multiple pregnancy.

Healthcare provider taking pregnant woman's blood pressure.
Keep up with your prenatal visits to help ensure a healthy multiple pregnancy.

Preterm labor

Preterm labor means labor before week 37 of pregnancy. Preterm labor can cause your babies to be born too soon. The babies may then have health problems. A woman carrying multiples is more likely to have preterm labor. Learn the signs of preterm labor. When caught in time, preterm labor can be managed and even stopped.

Call your healthcare provider right away if you have any of these before week 37 of pregnancy:

  • Strong contractions

  • 4 or more contractions per hour

  • Constant menstrual-like cramping

  • Sudden or constant low-back pain

  • Mucous or bloody vaginal discharge

  • Bleeding or spotting in the second or third trimester


Preeclampsia is a condition that includes high blood pressure (hypertension), swelling, and signs of organ problems. It may be more likely in a multiple pregnancy. It can show up around week 20 of pregnancy. It often goes away by 12 weeks after you give birth. It can lead to serious health risks for you and your baby. During your pregnancy, your healthcare provider will watch your blood pressure.

Preeclampsia can also cause these health problems in you:

  • Seizures

  • Kidney failure

  • Liver rupture

  • Brain bleeding

  • Stroke

  • Fluid in the lungs

  • Blood-clotting problems

This condition is also dangerous for the babies. It prevents the placenta from getting enough blood to them. They can't get enough oxygen and nutrients. As a result, the babies may be born too small (low birth weight). They may have other health problems.

Treatment depends on how severe the condition is. In all cases, you and your baby will be closely watched. In some cases, you may need bed rest. And in a severe case, you may need to go to the hospital for treatment or delivery.

Call your healthcare provider right away if you have any of these:

  • Swelling in your face or hands

  • Fast weight gain

  • Little or no urine

  • Blood in your urine

  • Severe headache

  • Belly (abdominal) pain on your right side

  • Vision problems (flashes or spots or blurred vision)

  • Nausea, vomiting, or both

  • Feeling that the babies’ movements have slowed

  • Not feeling the babies moving

Gestational diabetes

This is diabetes that happens only in pregnancy. Changes in the body cause blood sugar to be too high. This can be a problem in any pregnancy. But there is a higher risk in a multiple pregnancy. High blood sugar makes preeclampsia more likely. High blood sugar can also cause the babies to grow too large. This can lead to problems in late pregnancy and during birth.

Babies born to a parent with gestational diabetes may have problems after birth. These include breathing problems and low blood sugar. Controlling your blood sugar can help prevent these problems. If you have this condition, you may need to see diabetes specialists. These include a healthcare provider and dietitian. They will discuss treatments with you. This includes eating to control your blood sugar. You may also need medicines.

Call your healthcare provider right away if you have any of these:

  • You’re thirsty all the time

  • You pee often and a lot each time

  • You’re tired all the time

  • You have vaginal yeast infections that keep coming back

Placenta problems

The placenta gives the babies nourishment. It also removes waste. With a multiple pregnancy, more than 1 baby may share 1 placenta. Or each baby may have its own placenta. The most common problems are placental abruption and placenta previa. Placental abruption is when the placenta starts detaching from the uterus before it’s time to give birth. This can cause pain and bleeding. But an abruption may not cause bleeding. With placenta previa, the placenta covers the cervical opening. With either condition, bleeding may happen when the due date nears and the cervix starts to open.

In mild cases, the healthcare provider will watch you and your babies. If you have a placenta previa, the babies may be delivered right away by C-section. If you have a placenta previa, don't have sex or let anyone check to see if your cervix is open. This could cause bleeding.

Call your healthcare provider right away if you have any of these:

  • Bleeding from the vagina

  • Belly pain

Iron-deficiency anemia

Your body uses iron to make red blood cells for you and your babies. These cells carry oxygen. Anemia is when the body’s red blood cell count is too low. In pregnant people, this is often caused by too little iron in the blood. It's also known as iron-deficiency anemia. This condition is common in a multiple pregnancy. If your iron-deficiency anemia isn't treated, your babies may be born too small. The babies may have other health problems. A routine blood test called a CBC (complete blood count) can find this problem. This test is done on all pregnant people. It's done at 1 of the first prenatal visits. A repeat blood test is done at 28 weeks for all pregnant people. If you have anemia, follow your healthcare provider’s advice for treating it. You may need to eat foods high in iron and take iron supplements.

Call your healthcare provider right away if you have any of these:

  • Feeling tired all the time

  • Dizziness

  • Pale skin

  • Shortness of breath

  • Fast heartbeat

Fetal growth restriction (FGR)

FGR means a baby is not growing at a normal rate inside the womb. They are smaller than normal. There are different causes of FGR. These include preeclampsia, shared placenta, and genetic disorders. With a multiple pregnancy, FGR is fairly common. One baby or all babies may be affected. A baby with FGR may have health problems. These include low blood sugar and not enough oxygen at birth. They may have trouble fighting infections or keeping a normal body temperature after birth. You will not feel any symptoms of FGR. But you can take steps to help prevent it from affecting your babies. These include:

  • Eat enough food. Ask your healthcare provider how much to get.

  • Don't smoke.

  • Get enough rest. Ask your provider how much to get.

Online Medical Reviewer: Donna Freeborn PhD CNM FNP
Online Medical Reviewer: Heather M Trevino BSN RNC
Online Medical Reviewer: Irina Burd MD PhD
Date Last Reviewed: 12/1/2021
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