News Moms Need

A maternal-fetal medicine specialist is an obstetrician who concentrates on the care of pregnant women and babies in high-risk situations. Another name for this doctor is a perinatologist.

A maternal-fetal medicine specialist treats women with a number of conditions. Complications with mom’s health, include:
• A history of multiple miscarriages or premature birth
• Diabetes (gestational or preexisting)
• Hypertension (high blood pressure)
• Preeclampsia
• Infectious disease (toxoplasmosis, parvovirus, HIV/AIDS, etc.) or chronic illness
• Rh disease
• A family history of heart, kidney, or other disease

A maternal-fetal medicine specialist often treat pregnant women who are carrying multiples (twins, triplets or more) as the risk for preterm birth is significantly increased.

This doctor also specializes in the care of women whose baby is known to have:
• Abnormal fetal growth
• A known birth defect or suspected genetic disorder, such as Down syndrome, Trisomy 13 or Trisomy 18
• A baby with macrosomia (too large)
• A baby with fetal growth restriction (too small)

If you find yourself in a position where the risk of complications is higher than the average pregnancy, ask your current health care provider for a referral to a maternal-fetal medicine specialist. You may or may not need the extra care, but it will be good to get a second opinion.

Being pregnant with one baby has its ups and downs, but twins, triplets and up can be a big challenge.

Today, more than 3 percent of babies in this country are born in sets of two, three or more; about 95 percent of these multiple births are twins. The high number of multiple pregnancies is a concern because women who are expecting more than one baby are at increased risk of certain pregnancy complications, including premature birth (before 37 completed weeks of pregnancy).

Women who are expecting multiples generally need to visit their health care providers more frequently than women expecting one baby. These extra visits can help prevent, detect and treat the complications that develop more often in a multiple pregnancy. Health care providers may recommend twice-monthly visits during the second trimester and weekly (or more frequent) visits during the third trimester.

Starting around the 20th week of pregnancy, a health care provider monitors the pregnant woman carefully for signs of preterm labor. He/she may do an internal exam or recommend a vaginal ultrasound to see if the woman’s cervix is shortening (a possible sign that labor may begin soon).

Even if a woman pregnant with multiples has no signs of preterm labor, her provider may recommend cutting back on activities sometime between the 20th and 24th weeks of pregnancy. She may be advised to reduce her activities even sooner and to rest several times a day if she is expecting more than two babies.

As a multiple gestation progresses, the health care provider regularly checks the pregnant woman’s blood pressure for preeclampsia. He/she also may recommend regular ultrasounds starting around 20 weeks of pregnancy to check that all babies are growing at about the same rate.

During the third trimester, the provider may recommend tests of fetal well-being. These include:
    -  The non-stress test, which measures fetal heart rate when the baby is moving
    -  The biophysical profile, which combines the non-stress test with an ultrasound

The chance of a cesarean birth is higher in twin than in singleton births. However, a pregnant woman has a good chance of having a normal vaginal delivery if both babies are in a head-down position and there are no other complications. When a woman is carrying three or more babies, a cesarean birth usually is recommended because it is safer for the babies.

To learn more about multiples, read this article.

In this video, Dr. Siobhan Dolan talks with a woman about fertility treatment and how to lower one’s chances of getting pregnant with twins, triplets or more.

Identical twins (also called monozygotic twins) occur when one fertilized egg splits and develops into two (or occasionally more) fetuses. The fetuses usually share one placenta. Identical twins have the same genes, so they generally look alike and are the same sex. A woman’s chances of having identical twins are not related to age, race or family history.

Fraternal twins (also called dizygotic twins) develop when two separate eggs are fertilized by two different sperm. Each twin usually has its own placenta. Fraternal twins (like other siblings) share about 50 percent of their genes, so they can be different sexes. They generally do not look any more alike than brothers or sisters born from different pregnancies. Fraternal twins are more common than identical twins.

Triplets and other higher-order multiples can result from three or more eggs being fertilized, one egg splitting twice (or more), or a combination of both. A set of higher-order multiples may contain all fraternal siblings or a combination of identical and fraternal siblings.  Read our fact sheet if you want to know more about being pregnant with multiples.

Today, more than 3 percent of babies in this country are born in sets of two, three or more; about 95 percent of these multiple births are twins. The high number of multiple pregnancies is a concern because women who are expecting more than one baby are at increased risk of certain pregnancy complications, including premature birth (before 37 completed weeks of pregnancy). 

About 60 percent of twins, more than 90 percent of triplets, and virtually all quadruplets and higher-order multiples are born premature. The length of pregnancy decreases with each additional baby. On average, most singleton pregnancies last 39 weeks; for twins, 35 weeks; for triplets, 32 weeks; and for quadruplets, 29 weeks.

More than half of twins and almost all higher-order multiples are born with low birthweight (LBW), less than 5½ pounds or 2,500 grams.  LBW can result from premature birth and/or poor fetal growth. Both are common in multiple pregnancies.

LBW babies, especially those born before about 32 weeks gestation and/or weighing less than 3 1/3 pounds (1,500 grams), are at increased risk of health problems in the newborn period as well as lasting disabilities, such as mental retardation, cerebral palsy,  and vision and hearing loss.   While advances in caring for very small infants has brightened the outlook for these tiny babies, chances remain slim that all infants in a set of sextuplets or more will survive and thrive.

Preeclampsia and diabetes  in the mother are two conditions that, for the safety of the mother and baby, can lead to an early delivery. Women expecting twins are more than twice as likely as women with a singleton pregnancy to develop preeclampsia. Gestational diabetes can cause the baby to grow especially large, increasing the risk of injuries to mother and baby during vaginal birth and making cesarean delivery more likely.  Babies born to women with gestational diabetes also may have breathing and other problems during the newborn period.

Have you or someone in your family had twins or triplets?  Were they in the NICU?

Most of us know the story of Nadya Suleman. She’s the woman in California who had high-tech fertility treatments and wound up having eight babies.

Such sophisticated treatments increase the chances of multiple pregnancy (twins, triplets or more). They also can lead to health problems for mom and babies.

Did you know that fertility pills also increase the risk of mutiples? 

If a woman is having trouble getting pregnant, doctors often begin fertility treatment by giving her a prescription for pills. These pills help her body release eggs (ovulate). Some of the names of these types of pills are Clomid, Serophene and clomiphene.

These pills are used much more commonly than high-tech fertility procedures. They probably play a major role in the serious problem of premature birth in the United States. Multiple pregnancy can be riskier for a woman and her babies than a pregnancy with only one baby.

If you are thinking about fertility treatment or are already taking the pills, talk to your doctor to learn more about their risks and benefits. For more info, read today’s news release from the March of Dimes.

The rising number of multiple pregnancies is a concern because women who are expecting more than one baby are at increased risk of certain pregnancy complications, including preterm delivery (before 37 completed weeks of pregnancy). There are a number of steps a pregnant woman and her health care provider can take to help improve the chances that her babies will be born healthy.

To help couples achieve the best outcomes from fertility therapy, the March of Dimes, the American College of Obstetricians and Gynecologists, and the American Society for Reproductive Medicine have prepared the paper “Multiple Pregnancy and Birth: Considering Fertility Treatments.” 

To download the paper (pdf, 1.1mb), click here.