Are All Twin Pregnancies High Risk?

Women pregnant with twins have all sorts of questions from “How much weight should I gain?” to “Which prenatal tests should I undergo?” But no question is more complex or confusing than, “Is my twin pregnancy high risk?” I see this question everywhere on Internet pregnancy forums, and frankly, some of the answers that well-meaning posters give are just plain wrong. With that in mind, I decided to devote a post to that one question.

So are all twin pregnancies considered high risk?

Simple answer—yes. If you are pregnant with twins, triplets or other higher-order multiples, your doctor will consider you “high risk” regardless of your age, previous medical history, or lifestyle.

Why, you ask? Blame it on a design glitch—the female body was never meant to carry more than one baby at a time. Therefore, a woman expecting multiples has a greater chance of complications such as preeclampsia, gestational diabetes, placenta previa and of course, preterm labor than say, her neighbor who’s expecting a singleton. Furthermore, the babies could run into a bit of trouble as well. If a mom is having monozygotic or identical twins, for instance, her babies have a slight risk of developing twin-to-twin transfusion syndrome (TTTS), a rare but serious progressive disorder that occurs in a small percentage of identical twins who share a common placenta.

The medical community agrees as well. The Mayo Clinic website states, “Specific factors that might contribute to a high-risk pregnancy include [a multiple pregnancy.] Pregnancy risks are higher for women carrying twins or higher order multiples.”

The National Institutes of Health says,  concurs. “Risk factors for a high-risk pregnancy can include [multiple births.] The risk of complications is higher in a twin pregnancy and increases with more fetuses in the uterus.”

That said, however, I do need to make a distinction here. Although it’s true that all twin pregnancies are high risk, you personally may not ever develop a single complication. For instance, my pregnancy was considered high risk not only because I was carrying twins but I was also 36 years old at the time. A double whammy! Yet I sailed through my pregnancy without so much as a hangnail. In fact, whenever I went to my prenatal appointments (and with a high-risk pregnancy, I had way more appointments than if I were expecting a singleton), I would be teased with the same lighthearted joke. After I would dutifully pee in a cup, stand on the scale and then have my blood pressure taken, my nurse would exclaim, “You should be the poster child for twin pregnancy! You’re lookin’ that good!”

pregnant woman talking on telephoneIf you are expecting twins, you may never need to see a perinatologist (a doctor who specializes in high-risk pregnancies) or go on bed rest but having a “high risk” classification is still important to your twin pregnancy. First, many insurance companies will then step up and cover any additional medical expenses that you may incur (i.e. prenatal tests). But more importantly, I believe that knowledge is power. Knowing that you fall into this category makes you hyper aware, diligent, curious, eager for more information—information that could help you get the best possible care for you and your babies. Information that could possible save the lives of your babies. When you know that you may go into preterm labor, for instance, you’re more apt to learn the warning signs and perhaps prevent a preterm delivery. Or, you may be more apt to pack on the pounds early in your pregnancy, an important step in building a strong and healthy placenta.

So don’t be afraid of a high-risk classification. Own it, baby! Wear it! And make it work for you!

Photo of Double Duty

7 thoughts on “Are All Twin Pregnancies High Risk?

  1. Lara van Staden

    Hi there,I really find your posts so helpfull and I think there are lots of other moms of multiples that also benefit from your blogg.

    I had a high risk pregnancy at age 31 with our identical (mono-di) boys as they were diagnosed with Downs syndrome, hydrocephalus, chromosome defects and our leading twin Dawid was diagnosed with 5 heart deffects and all of this was confirmed at almost every appointment. The drs didn’t make mistakes and even we as laymen couldn’t miss the facts.

    After all this our drs suggested abortion. Medically we had more than enough backing reasons to, but we prayed about it and found God’s grace to not abort our beautiful boys and to choose life fore them. Today they are two beautiful bubbly toddlers of 2 and a half years old and have no end.

    They were born full term (38weeks) and Dawid weighed 2,5kg and Josua 2,4kg. I had a very healthy pregnancy without mommy complications. The Lord gave us our miracle boys and they are perfect in every possible way with no Downs, chromosome defects or hydro cephalus, unfortunatly Dawid needed 2 heart surgeries, but his sugery is only part of history in his life he is actually the busier one of my boys. Josua is Dawid’s wingman and the most gentle hearted person I know he is always out to give hugs and Dawid is our bundle of life, happiness and joy. Our boys, like I’m sure all of the moms and dads would say fill our days with fun, joy, laughter and most importantly LOVE!

    May our story/testimony bless and encourage all of you wonderful parents that are blessed with twins and more.

    Blessings,
    Lara van Staden

    P.S. If anyone need prayer or just someone to talk to you can ask Christina for my email adress and email me.

    Reply
      1. Lara van Staden

        You’re welcome I trust our story will encourage everyone. Thanks for the wonderful webpage. xxxLara

        Reply
  2. Michael Ray Overby

    Christina we need you to do some Correction to your assertions about Twin Twin Transfusion Syndrome! If you are calling it “Rare” that’s only beacuse Monochorionic Pregnancy is rare! Within that environment it is Common, at a rate of between 14 & 20%. That’s somewhere between One in Seven and One In Five Shared Placenta Pregnancies. Mom NEEDS to have an MFM or PERI on this type of very special pregnancy. She alsop needs Ultrasound every 2 weeks (another thing you Do Not Emphasize) to check the fluid levels. Please help us get the word out…

    Reply
    1. Christina Baglivi Tinglof Post author

      Thanks for commenting. You are right — within monochorionic pregnancy it is a greater risk. Yet within twin pregnancy in general, it is still rare. No, I don’t emphasize ultrasound or fluid levels — that wasn’t the point of the post. Perhaps in the future I’ll dig in a little further!

      Reply
  3. Krystal

    . How is TTTS rare? Facts are it is not rare and is coming more common in the modi and momo world . You can’t classify didi to monochorionic twin pregancy. It’s nothing a like and less risk. Yes didi can have a fussed placenta and get TTTS but that is RARE! MoDi twins without TTTS are more frequent (80%) but have been scarcely reported.Monochorionic (MC) twins account for about 20-30% of all twins, but contribute disproportionately to mortality, intrauterine growth restriction, and preterm delivery compared with dichorionic (DC) twins. This higher mortality in MC twins is likely due to the effects of placental morphologic characteristics, which include complex vascular communications between the twins associated with twin-twin transfusion syndrome (TTTS).The relatively broad incidence range of TTTS likely reflects differences in clinical criteria used to make the diagnosis.TTTS is a progressive disease
    inwhichsuddendeteriorationsinclinicalstatuscanoccur,leadingtodeathofaco-twin.
    Up to 30% of survivors may have abnormal neurodevelopment as a result of the
    combination ofprofoundantenatal insult and the complications of severe prematurity. I find it amazing how this is rare and the mortality rate for modi and momo is much higher then didi twins.it’s a whole other classification

    Reply
    1. Christina Baglivi Tinglof Post author

      You are obviously very passionate about this subject, and it sounds as though it has touched your life deeply. I’ll continue to do my best to get the word out.

      Reply

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