Everything you need to know about expecting multiples. We hope that the advice and tips we mentioned will help you.
When Sarah Daniels was 4 weeks pregnant, she suspected that she could be carrying more than one baby. Her pants fit tight in the waistline and her human chorionic gonadotropin (hCG) beta blood test results came back at an eye-opening 5,221 mIU/ml.
“My nurse practitioner told me they never diagnose multiples from just the hCG and progesterone levels, so we had an early ultrasound at 6 weeks,” says Daniels, a special education teacher from Indianapolis, Ind. “She told me not to panic, but my hCG level had doubled to 10,000 and then again to 20,000. With test results that high, I was scared there were three. During my first ultrasound, I was so nervous we wouldn’t hear two heartbeats that I was crying and shaking.
“Afterwards, I felt so happy and blessed to be having twins, but then I also felt overwhelmed until about 3:30 a.m. that next morning. I even woke up my husband, Keith, in the middle of the night and said, ‘What are we going to do? We can’t afford twins!’”
With a strong family history of multiples and having been previously prescribed a 150 milligram-dose of clomiphene citrate (Clomid), the popular infertility drug that can stimulate ovaries to produce eggs, Daniels is not surprised that she is expecting twins.
“Two of my cousins have had twins,” she says. “And my grandma was pregnant with three sets of twins and one set of triplets, which she unfortunately miscarried.”
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A Growing Trend
If it turns out that two or more are on the way, you’re not alone. A recent study published in Obstetrics & Gynecology found that the overall multiple birth ratio increased dramatically between 2000 and 2019. Some researchers and physicians suggest increased use of fertility drugs such as Clomid and infertility treatments such as in vitro fertilization have resulted in this booming multiple-birth trend.
“Of women whose only fertility problem is irregular or no ovulation at all, about 80 percent will ovulate and about 50 percent will become pregnant within six months of Clomid treatments,” says Dr. Gary S. Berger, an InterNational Council on Infertility Information Dissemination Inc. (INCIID) advisory board member and co-author of The Couple’s Guide to Fertility: How New Medical Advances Can Help You Have a Baby. “About 3 percent of women on Clomid have a multiple pregnancy, usually twins, compared with about 1 percent in the general population.”
“When I was at Babies ‘R Us registering for my baby showers, the woman helping me said that we were the 75th set of twins to have signed up so far this year,” Daniels says. “I wasn’t too surprised since there are tons of people involved in my twins club support group here in Indy.”
There are a few telltale symptoms in the first trimester that could indicate multiples are in your future. Expecting multiples may cause more severe pregnancy symptoms such as increased fatigue, urination, morning sickness and weight gain. However, not everyone will experience increased symptoms of multiple pregnancy; therefore, any early signs should be discussed with a health care professional.
“I had all the symptoms of a singleton pregnancy, but I noticed that they were elevated compared to what my friends and family have experienced,” says Daniels. “Early on I would be out of breath when I would rush to the phone or be really tired when I would walk up the stairs. My pulse increased faster, and I have not stopped going to the bathroom since I became pregnant.”
As a mother of 13-year-old boy-girl twins and one 16-year-old son, Nancy Bowers, RN, BSN, knows firsthand that more babies on the way can mean increased symptoms. Bowers is also creator of the Marvelous Multiples® prenatal multiple birth classes in Atlanta, Ga., and author of The Multiple Pregnancy Sourcebook. She says she has heard more than 1,000 similar testimonials from expectant families since starting the Marvelous Multiples® program.
“With all the discomfort of a singleton pregnancy, you’re probably going to see that much earlier with multiples,” says Bowers. “The No. 1 symptom I’ve seen is elevated morning sickness or nausea. Women tend to get bigger faster, and the pressure on the bladder is always there and you never seem to find relief because the uterus doesn’t rise like with a singleton pregnancy after the first trimester. Also, there is more muscle strain, and the mothers are more tired because the babies are pulling on more of their nutritional resources.”
Although it would be ideal if all mothers-to-be had that special intuition or definite sign indicating they are expecting multiples, such presentiments usually take the backseat to good, old-fashioned science.
When a multiple birth is suspected, doctors closely monitor hCG and progesterone levels, which can be higher due to increased hormone levels. ““An hCG beta blood test can detect pregnancy as early as 10 days after fertilization, and hCG beta numbers should increase by an average of 60 percent every two days,” says Dr. Scott Roseff, moderator for the INCIID General Infertility Forum and advisory board member.
“Interestingly, some published studies showed that the hCG levels for a multiple pregnancy aren’t much different from and don’t rise more rapidly than in a singleton pregnancy, while some other studies showed the hCG levels were higher (but didn’t rise more rapidly),” says Dr. Roseff. “In general, though, it appears that the hCG levels are similar in the early part of the first trimester while the hCG levels are higher in the second and third trimester for multiples compared to singletons.”
Because of this variance, most health care professionals do not use hCG levels to diagnose a multiple birth, cautions Bowers. “Generally, it’s the ultrasound that makes the final diagnosis,” she says. “A woman’s hCG level will increase on an exponential basis, especially if she is expecting multiples. If the level doesn’t increase, then she will know she’s not pregnant.”
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Confirming Multiple Pregnancy
Bowers stresses the importance of early ultrasound to officially diagnose multiple pregnancy and more closely monitor the babies’ health. “The hCG levels are clues, while the ultrasound is the ‘Real McCoy,’ a definitive answer,” she says.
Dr. Roseff agrees. “Combining hCG testing and ultrasound monitoring is far better than hCG levels alone,” he says.
Ultrasounds are also very important to maintain both the mother’s and babies’ health in a multiple pregnancy, according to Bowers. She says ultrasound can determine if there is a single placenta or if the babies have separate placentas, especially during the first trimester. “As the babies get bigger, it’s hard to see the tissue and layers of the placenta,” she says.
But no matter whether you’re expecting two, three – or even just one – be sure to see your health care provider regularly to ensure the best possible outcome for both you and your babies.
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The names of the people mentioned in the article have been changed for security reasons and to protect privacy.