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Twins and multiples - Healthy multiple pregnancy

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Find out how to stay healthy in pregnancy and what type of antenatal care you can expect.

A healthy lifestyle and diet will help you cope with multiple pregnancy and give your babies the best start in life.

The advice for keeping healthy in pregnancy is similar whether you're expecting multiples or just one baby. 

Eat well, take gentle exercise, drink lots of fluid and, if you feel stressed, get support from friends and family or talk to your midwife.

You can find information on what to eat and what to avoid, and how to keep active, as well as advice on smoking, alcohol, medicines and drugs, in the Pregnancy care planner.

Very little research has been done on nutrition during multiple pregnancy, so the best advice is to eat a balanced, healthy diet. If you feel hungry during your pregnancy, fill up on healthy snacks. Expecting two babies doesn't mean you have to eat significantly more than during a single pregnancy.

You may be offered iron supplements during your pregnancy as you're more at risk from anaemia during a twin pregnancy. Discuss this with your midwife or doctor.

The Twins & Multiple Births Association (Tamba) has produced The Healthy Multiple Pregnancy Guide, which should be given to all women expecting twins or more by their antenatal care team. If you register with Tamba on their website, you can also download it free.

It provides in-depth information on multiple pregnancy, including common health problems, complications, keeping healthy, rights and benefits, preparing for the birth and the birth itself. 

What antenatal care can I expect?

Because there are increased risks associated with a multiple pregnancy, especially if your babies share a single placenta, good antenatal care is essential.

It's important to attend the ultrasound scan you will be offered between 8 and 14 weeks. This is the best time to determine the type of placenta and membranes your twins have (chorionicity), check your dates and have a nuchal translucency test for Down's Syndrome done.  A scan to check for structural abnormalities will be performed around 18-22 weeks.

The number of check-ups and scans you will be offered will depend on the type of twins or multiples you're having.

Types of twins

There are three types of twins. The biological principles are the same for triplets, though these are more complex than with twin pregnancy. The three types of twins are as follows:

  • Dichorionic diamniotic (DCDA) twins each have their own separate placenta with its own separate inner membrane (the amnion) and outer membrane (the chorion).
  • Monochorionic diamniotic (MCDA) twins share a single placenta with a single outer membrane and two inner membranes.
  • Monochorionic monoamniotic (MCMA) twins share both the inner and outer membranes. 

All non-identical and one-third of identical twins are DCDA. The other two-thirds of identical twins are MCDA, and just 1% of identical twins are MCMA.

The percentages of identical and non-identical twins born in the UK are not routinely recorded but, according to the Multiple Births Foundation, around one-third of twins are identical.

What extra care can I expect?

If your babies are monochorionic diamniotic (MCDA), you can expect more scans and monitoring as these types of twins have the highest risk of Twin-Twin Transfusion Syndrome (TTTS), an abnormality of the placenta.

For more information on TTTS, see Risks of multiple pregnancy. The scans are usually every two weeks from 16 weeks, and you may be referred to your regional hospital with a centre for foetal care to be seen by a specialist doctor.

If your babies are monochorionic monoamniotic (MCMA), you will also have frequent scans, as with these types of twins there is often some cord entanglement, which can cause complications.

These types of twins are rare and so you can expect to receive specialist care and close monitoring. You should be seen by a foetal medicine specialist who has cared for these types of twins before. At the moment, the usual practice is an elective delivery at 32-33 weeks.

If your babies are dichorionic diamniotic (DCDA), the risks to their health in the womb are much lower. You will usually be scanned every four weeks.

It's important to attend all your appointments as this will allow any problems to be picked up early and treatment to be offered where necessary.

For more information on antenatal care and screening, see the Pregnancy care planner: antenatal care.

Medical Review: July 10, 2010

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