When I was pregnant with my twins more than 18 years ago, there weren’t many health guidelines specific to a twin pregnancy. I was confused about how much I should eat or whether I should continue exercising, for instance. There were, however, lots of horror stories about preterm labor, premature birth, and low-birth weight babies yet limited advice on how to try and side step these terrible and scary scenarios. Fortunately for you—mom expecting twins—things have changed! Now there are lots of concrete studies that illuminate what it takes for a healthy twin pregnancy. For instance, we now know that protein is key to forming a healthy placenta and packing on the baby weight, two important factors in the fight against preterm labor. Still, many doctors are not accustomed to regularly treating multiple pregnancies, or are simply not well read when it comes to caring for patients carrying twins. That’s where this post comes in! What follows are a list of questions you should ask your physician about your twin pregnancy. (And the answers you should be hearing.)
How much weight should I gain?
Recent research has shown that when it comes to moms expecting twins, it’s all about packing on the pounds as there’s a strong correlation between proper weight gain and healthy fetal growth. (Studies suggest that sufficient weight gain before Week 20 aides in the development and function of the placenta.) Women of normal weight (pre-pregnancy) need to gain between 37 and 51 pounds, while overweight women should gain anywhere between 31 to 50 pounds. If your doctor believes those goals are too high, you may want to ask why.
Should I seek the advice of a perinatologist?
A perinatiologist is an obstetrician who specializes in high-risk pregnancies (and yes, if you are pregnant with twins, you are high risk regardless of your age). These are doctors who are highly trained and evaluate multiple pregnancies on a daily basis. Furthermore, they are up-to-date with the latest research, able to make complex diagnoses, and are adept at performing difficult procedures such as a double amniocentesis. But should you see one? If you are of an “advanced maternal age,” in a “high-risk group” (think high blood pressure, diabetes, and so forth), have had a complicated pregnancy in the past (or are experiencing complications now), or are in the market for a new obstetrician any way, than by all means make an appointment with one.
Are my twins monozygotic (or identical), and if so, do they share a placenta?
Not all twins are created equal! In fact, if your twins are identical (or monozygotic), they may need special medical attention. If they share a single placenta, they may develop twin-to-twin transfusion syndrome (TTTS), a potentially dangerous condition caused by an abnormal blood vessel connection between the two fetuses. But don’t rely on your doctor’s “best guess.” Instead, insist on a chorionicity scan (ideally between Week 10 to 13), a simple ultrasound that determines if your twins have separate or a shared placenta. If it is determined that your twins are in fact monoamniotic, you should seek the care and advice of a perinatologist since early detection of TTTS can lead to appropriate treatment and a successful outcome.
Is it OK to have sex during a twin pregnancy?
Many doctors fear that sex during a twin pregnancy can trigger preterm labor but research shows that sex is usually very safe during pregnancy, even a twin pregnancy, as long as your pregnancy is progressing normally.
Is bed rest really necessary?
Again, many doctors prescribe bed rest for women carrying twins to help combat the chance of preterm labor. Yet research doesn’t back up the practice. In fact, for some women, bed rest can actually increase their chances for preterm labor. Still, resting while pregnant with twins is very important (you just may not need to be on round-the-clock bed rest). Instead, make it a daily practice to lie down on your left side for 20 to 30 minutes several times a day. This will take the stress off your cervix while increasing the blood flow to your babies. Furthermore, the reduced activity is good for you, too. Less calories burned means more calories for your babies.
Is my cervical length shortening?
Doctors know that a change in cervical length (CL) is a predictor to preterm labor. Yet even normal cervical length halfway through your twin pregnancy (Week 20) is no guarantee that you will avoid going into labor early. In fact, recent studies have shown that when CL shortened 13 percent or more four to five weeks after their initial measurement, moms carrying twins had a significantly greater chance for preterm delivery before Week 32 to 34. So around Week 20, ask your doctor for not one but two ultrasounds (spaced four to five weeks apart) to measure the length of your cervix.
Will you induce me if I go past Week 37?
Even if your pregnancy is progressing normally, Week 37 is best for delivery according to new research. After Week 37, complications arise for women carrying twins due to reduced space in the womb as well as the rapid breakdown of the placenta. Therefore, electing to have your twins at Week 37, not Week 40, is optimal for delivery, resulting in reduced risk to babies.