Are All Twin Pregnancies High Risk?

  • By: Sandra
  • Date: March 18, 2022
  • Time to read: 5 min.

Women pregnant with twins have all sorts of questions from “How much weight should I gain?” to “Which prenatal tests should I undergo?” But no question is more complex or confusing than, “Is my twin pregnancy high risk?” I see this question everywhere on Internet pregnancy forums, and frankly, some of the answers that well-meaning posters give are just plain wrong. With that in mind, I decided to devote a post to that one question.

So are all twin pregnancies considered high risk?

Simple answer—yes. If you are pregnant with twins, triplets or other higher-order multiples, your doctor will consider you “high risk” regardless of your age, previous medical history, or lifestyle.

Why you ask? Blame it on a design glitch—the female body was never meant to carry more than one baby at a time. Therefore, a woman expecting multiples has a greater chance of complications such as preeclampsia, gestational diabetes, placenta previa and of course, preterm labor than say, her neighbor who’s expecting a singleton.

Furthermore, the babies could run into a bit of trouble as well. If a mom is having monozygotic or identical twins, for instance, her babies have a slight risk of developing twin-to-twin transfusion syndrome (TTTS), a rare but serious progressive disorder that occurs in a small percentage of identical twins who share a common placenta.

The medical community agrees as well. The Mayo Clinic website states, “Specific factors that might contribute to a high-risk pregnancy include [a multiple pregnancy.] Pregnancy risks are higher for women carrying twins or higher order multiples.”

The National Institutes of Health says,  concurs. “Risk factors for a high-risk pregnancy can include [multiple births.] The risk of complications is higher in a twin pregnancy and increases with more fetuses in the uterus.”

Common pregnancy complications when carrying twins

That said, however, I do need to make a distinction here. Although it’s true that all twin pregnancies are high risk, you personally may not ever develop a single complication. For instance, my pregnancy was considered high risk not only because I was carrying twins but I was also 36 years old at the time.

A double whammy! Yet I sailed through my pregnancy without so much as a hangnail. In fact, whenever I went to my prenatal appointments (and with a high-risk pregnancy, I had way more appointments than if I were expecting a singleton), I would be teased with the same lighthearted joke.

After I would dutifully pee in a cup, stand on the scale and then have my blood pressure taken, my nurse would exclaim, “You should be the poster child for twin pregnancy! You’re lookin’ that good!”


Preeclampsia can occur in any pregnant woman, but it is far more common in women who are carrying twins. Preeclampsia is a high blood pressure disorder that usually develops around the 20th week of pregnancy but can potentially develop after the birth of the baby. If you’re carrying more than one fetus, the problem is likely to be more serious for you.

It is possible to suffer organ damage from preeclampsia, and your baby may be born early if you are suffering from severe preeclampsia. Dr. Sejour keeps an eye on you and gives you recommendations to help you prevent preeclampsia.

Gestational diabetes

Gestational diabetes is a kind of diabetes that occurs during pregnancy. Being pregnant with multiples increases your risk of developing gestational diabetes, which affects both your blood sugar levels and the blood sugar levels of your children. It also raises the likelihood of developing preeclampsia.

After giving birth, your blood sugar should return to normal within a short period of time. If you have gestational diabetes, on the other hand, you are now at an increased risk of developing Type 2 diabetes later in life.

Throughout your pregnancy, your doctor should keep a careful eye on you and administers glucose screening tests to ensure that you are healthy. He will place an order for medication if it is necessary.

You, too, have an important role to play. Regular, gentle twin pregnancy exercise, eating nutritious foods in your twin pregnancy diet, and limiting your intake of added sugar and salt all contribute to your overall health and the health of your unborn child.

Fetal Growth Problems

It is not uncommon for twins to have growth problems while still in the womb; it occurs in up to 25% of cases. Ultrasonography monitors the growth of your children. If one twin is significantly smaller than the other, the problem is known as discordant growth, and the doctor will do additional tests to evaluate whether further intervention is required.

Preterm birth

More than half of twins are born at fewer than 37 weeks of pregnancy, which is regarded as preterm. Premature babies are at increased risk for some short- and long-term health problems, but this does not imply that your baby will suffer from any of these problems. Premature babies may face difficulties breathing, feeding, and maintaining a normal body temperature. Babies born very prematurely can develop a variety of medical concerns as well.

What You Should Do If Expecting Twins

If you are expecting twins, you may never need to see a perinatologist (a doctor who specializes in high-risk pregnancies) or go on bed rest but having a “high risk” classification is still important to your twin pregnancy.

First, many insurance companies will then step up and cover any additional medical expenses that you may incur (i.e. prenatal tests). But more importantly, I believe that knowledge is power. Knowing that you fall into this category makes you hyper-aware, diligent, curious, eager for more information—information that could help you get the best possible care for you and your babies.

Information that could possibly save the lives of your babies. When you know that you may go into preterm labor, for instance, you’re more apt to learn the warning signs and perhaps prevent preterm delivery. Or, you may be more apt to pack on the pounds early in your pregnancy, an important step in building a strong and healthy placenta.

So don’t be afraid of a high-risk classification. Own it, baby! Wear it! And make it work for you!