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Multiple Births on the Rise

Monday, January 20th, 2014

If you feel like there are more twins, triplets, and more around than ever before, you’re not imagining it. Multiple births have increased since 1980, when one in every 53 babies born was a twin; in 2009, that number had risen to one in every 30. That’s a 76% increase in twin births in roughly 30 years.

One (smaller) reason for the spike is older maternal age. Older women are more likely to release more than one egg at a time (with or without fertility drugs), making multiple gestation a possibility more often. Incidentally, this does not pertain to identical twins, who are formed from a single fertilized egg.

Another reason, one which is responsible for a larger share of the increase, is the use of fertility drugs in women trying to become pregnant. Fertility treatments have attracted some attention in recent years following the birth of eight babies by the so-called “Octomom.” In that case, 12 embryos made from an IFV treatment were implanted into the woman’s uterus and the result was eight viable fetuses.

This was a clear case of poor judgment. Most cases of infertility are not treated with IVF, but rather with drugs that stimulate the ovaries to produce eggs. These drugs encourage hormone production, which aids in conception but also increases the chances of multiple gestation.

When women are undergoing treatment via fertility drugs, their doctors routinely monitor, via ultrasound and blood tests, how many eggs are being produced so that the couple can avoid trying to conceive during a month when there are too many. However, in some cases the monitoring is not done, or the couples disregard the advice given to them. Often doctors who have been demonized for “allowing” a woman to become pregnant with more than one or two babies during fertility treatments have actually given the woman advice that would have prevented the multiple pregnancy, had it been followed.   

There are good reasons to avoid having twins (or other multiples) whenever possible. Twin pregnancies are considered higher-risk pregnancies, and are usually more difficult for the mother than singleton pregnancies – especially older mothers, who no longer have the energy they had in their 20s. In addition, caring for more than one newborn baby at a time is exhausting, even when plenty of help is available. The exhaustion and expense factors increase exponentially with each additional newborn. It’s also extremely difficult to maintain social and emotional health during those early years with twins or more.

If you do find yourself pregnant with twins or more, take steps as soon as possible to maximize your odds of a healthy pregnancy and delivery, and learn all you can about ways to make taking care of multiples – not just as newborns, but through the challenging toddler and preschool years as well – as simple as possible.

– Yvonne S. Thornton, M. D., M. P. H.

Congratulations, It’s Twins!

Thursday, October 31st, 2013

An increasing number of expectant parents are hearing those words these days. If you are expecting twins (or more), then one of two things has happened. In natural twinning, either your body has released two eggs, and they have both been fertilized, or one fertilized egg has split into two. The former will result in fraternal twins; the latter, identical.

Learning that you are expecting twins is normally quite a shock. It can take some time for the news to sink in, and for all the concerns and questions to arise. You may be concerned about pregnancy complications or what the birth will be like; you make also worry about being able to cope with having two babies at once. These concerns are completely normal and common.

Realize that the majority of twin pregnancies turn out just fine. You can probably expect to be tired throughout the pregnancy and require a lot of rest; this is your body telling you what it needs, so be sure to listen. Some pregnancy symptoms can be exacerbated with twins, such as morning sickness (which can actually occur any time of day). Your higher levels of hCG will often mean more nausea and possibly vomiting than women with singleton pregnancies experience.

Later in your pregnancy, you may also experience other symptoms to higher degrees, such as shortness of breath, constipation, heartburn, and bloating. Back or hip pain may also be more of a problem as your babies grow.

Another difference you will notice in your twin pregnancy is increased weight gain. Understand that if your are average weight, you will need to gain more weight than women who are carrying only one fetus – but also realize that it needn’t be a lot more. While mothers of a singleton pregnancy need only eat 100-300 calories more per day, a mother of twins needs to ingest about 500 more calories per day. More may be advised if she is underweight to start with; if she is overweight, less is fine, as long as the babies are growing and healthy.

Mothers of twins should expect more prenatal care, as well. More ultrasound examinations are common to keep an eye on how well your twins are doing. You will also have regular blood pressure and urine checks, because as a pregnant woman expecting twins, you have a higher likelihood of developing high blood pressure, gestational diabetes, preeclampsia, and anemia.  Because of the higher risk of depleting the maternal iron and calcium stores with a twin gestation, additional supplementation with prenatal iron and calcium is prescribed in order to prevent anemia or osteoporosis later in life.

Look out for the same danger signs as in any other pregnancy and report them to your doctor immediately. If you aren’t sure whether a symptom is normal or not, or even if you just feel instinctively that something isn’t right, consult with your doctor to be on the safe side. Report any of the following symptoms to your doctor:

  • Severe headaches
  • Sudden swelling
  • Vomiting
  • Abdominal pain
  • Excessive fatigue

Take all the help you can get during this challenging pregnancy. Let others care for older children regularly so you can rest; allow your partner to run errands and do more than his or her normal share of the housework. The important thing for you to focus on is keeping yourself rested and healthy. And try not to worry; the fact is that the most likely outcome of your twin pregnancy is two healthy, normal babies.

– Yvonne S. Thornton, M. D., M. P. H.

There’s Something Genetic about Twins

Monday, November 12th, 2012

If you’re a mother of twins, you’ve probably had people come up to you and ask if twins run in your family. Many women have heard this before, but few are entirely certain whether or not the likelihood of giving birth to twins is truly genetic, or if it simply happens by chance. You might be surprised to find out that the notion isn’t entirely a myth. To understand the genetic forces behind having twins, you first need to understand how twins are born.

There are two types of twins a woman can have. Monozygotic twins are the ones that are identical, and their genetic build is essentially the same. These twins were formed after the mother’s egg was fertilized. The egg split into two and became two separate eggs, and eventually two separate people. Rest assured that this is simply a strange bodily occurrence, and there is nothing genetic about it.  It is nature’s cloning.

On the other hand, dizygotic twins are those that are fraternal. They might be different genders, and they look no more alike than regular siblings. These twins were actually formed when the mother released two eggs at the same time. Both eggs were fertilized separately and two people began to form. Here is where genetics come into play. If a woman has released two eggs at the same time, she is predisposed to hyperovulation. Most women release a single egg with every cycle, but women with dizygotic twins release two (or sometimes more in the case of multiples). Hyperovulation is in fact genetic. If your mother or grandmother experienced hyperovulation, you probably will too. Certain tribes in Africa are prone to multiple ovulation and consequently a high incidence of twinning.  Women of color, older women, women with several children (high parity) are more likely to have twins.  Conversely, Asian mothers are about half as likely to have dizygotic twins.

Women taking fertilization treatments using Clomid or Pergonal will be more likely to hyperovulate resulting in a dizygotic (or monozygotic) pregnancy or even higher-order multi-fetal gestations, such as Octomom.  Also, those women who are undergoing artificial reproductive technologies, such as in vitro fertilization, which may insert more than one fertilized egg into the uterus may have twins.   But these women are not genetically predisposed to carrying twins.  The bottom line is that if you or other members of your blood-related family are dizygotic twins and you’re trying to conceive, you might want to stock up on twice the amount of baby supplies.