What to Expect with Twin Pregnancy

  • By: Sandra
  • Date: March 18, 2022
  • Time to read: 8 min.

A twin pregnancy is not like being pregnant with just one (or “singleton pregnancies,” as we like to say). A twin pregnancy takes extra calories, many more visits to the doctor, plus more tests and ultrasounds.

In short, it takes more patience and planning.

But you can do it!

Below are 10 things you need to know if you are expecting twins. No sugar-coating; just the straight honest-to-goodness truth. But, hey, you are a strong woman because after all, you have superpowers. You can create twins!

You’re a high risk patient – Not Just High Blood Pressure

Let’s start out with a bang, shall we? Whether you’re 22 or 42, if you’re pregnant with twins, you’re considered a “high-risk patient.”


Statistically, women expecting twins are at a much higher risk for developing complications such as preeclampsia, gestational diabetes, and preterm labor. Twin moms babies are more prone to problems, too, many stemming from preterm delivery.

I’m not telling this to frighten you but rather to empower you! As a twin mom-to-be you need to be extra vigilant in your prenatal care right from early pregnancy. All twin pregnancies are high risk and we explain why in detail.

Antenatal Care

Keep all your appointments with your doctor and meet with a perinatologist who specializes in multiple pregnancies, slow down and get plenty of rest every day by lying on your left side to increase blood flow to the two babies, and make your diet your number one priority. Expect more frequent ultrasounds and lots more antenatal care than if you were carrying single babies. Antenatal appointments will be weekly from about six months onwards.

Carrying twins is hard on your body. For your health and your babies health, take it easy. Don’t try and be the super mom and keep up with the mom carrying one baby. A singleton pregnancy is much easier on the body.

Vanishing Twin Syndrome

Sometimes when women go in for ultrasounds there will be novisible evidence of one baby. This is called Vanishing Twin Syndrome, where the visible sac may not be growing as expected for the length of time you are pregnant.

More often than not, this is because there is only one child in the uterus and the other baby has vanished at some point during your early pregnancy. This can leave a mother grieving for a baby whilst still carrying a baby.

Fertility treatment has meant that this is becoming a more increasing situation.

Maternal Fetal Medicine

It is common for mothers carrying twins or multiples to experience more severe morning sickness than those carrying just one baby. Typically,the morning sickness experienced with a twin pregnancy is typically experienced further along into the pregnancy, making it more difficult to manage.

Giving birth naturally to twins or several babies can also be different than giving birth with one baby. You may find yourself going through labour twice or more times than if you were giving birth to one baby. You run the risk of having babies that are born at different times and require different levels of care, which means you may experience some post delivery separations from your babies.

Be prepared when you mean your twin pregnancy doctor, read our guide to 7 questions to ask your twin doctor.

Your weight gain matters in Twin Pregnancies

The research and data show a direct correlation between early maternal weight gain and strong fetal growth. According to new guidelines, a healthy mom pregnant with twins should gain between 37 – 54 pounds during her pregnancy with the biggest gains occurring during her first trimester.

With that in mind, shoot for a minimum of 2,700 calories a day (3,100 claories is optimal) in order to gain 24 pounds by Week 24. This often results in each baby tipping the scales at 5 pounds 8 ounces or higher at birth.

Researchers believe that early weight gain aids in the development and function of the placenta.

Protein is key in Multiple Pregnancy

Just how the heck are you supposed to gain that weight? Protein. The amino acids found in protein are essential in building cells and vital in the growth and development of fetal heart, brain, tissue, and muscle. In fact, research has shown that when a pregnant woman with a singleton consumes 80 grams of protein a day, her baby would weigh at least 6 pounds at birth.

A mom expecting twins should try to get at least 130 grams of protein each day. (Dr. Barbara Luke, an expert on maternal nutrition and author of When You’re Expecting Twins, Triplets, or Quads: Proven Guidelines for a Healthy Multiple Pregnancy, 3rd Edition, recommends 176 grams!) Think lean meat, chicken and fish. (Sardines, if you can handle them, are super high in protein.)

Peanut butter and other legumes such as lentils and soybeans are very high in protein. Eggs and dairy products such as yogurt and cottage cheese are other good options, too. Keep a food dairy to track your progress.

Early in your pregnancy, know If You Are Carrying Fraternal or Identical Twins

During your first ultrasound, ask your doctor to carefully examine your twins to determine their zygosity and if they share one placenta.

Why does it matter? 

Twins who are identical and share one placenta are monochorionic and are at risk of developing twin-to-twin transfusion syndrome (TTTS), a rare but potentially dangerous condition. You should have your twins zygosity tested.

Twin to Twin Pregnancy

The cause of TTTS is due to an abnormal blood vessel connection between the two fetuses. One twin gets too much blood while the other doesn’t get enough. If left untreated, the risk of death for one or both twins is very high. But when TTTS is diagnosed and treated early through the watchful eye of a maternal-fetal specialist, the chances of a positive outcome for both twins is much greater.

Fraternal twins do not share a placenta.

Your mother-in-law is your new best friend

Sure, she may tell you that you’re swaddling the babies all wrong or that you shouldn’t let your pet labradoodle in the nursery, but you need your MIL. As a matter of fact, you need anyone that is willing to come over and do a load of laundry or cook you a meal. Take any and all help. In the weeks leading up to the birth of your babies, think about what you’d like your new crew of volunteers to do for you.

Do you want them to take care of your home by doing the dishes and vacuuming thereby giving you time to bond with your babies, or would you prefer them to hold and care for your infants while you rest or shower?

Choosing Baby Names x
Choosing Baby Names

And know who would be better at which job as not everyone adores a new baby or is a good cook! Having a clear view of what you want and need before the arrival of your babies will help eliminate any miscommunication and create a more peaceful environment.

Your back will hurt, your feet will swell, it will be difficult to sleep, and people will constantly say, “Due any day?” when you’re only in your fifth month

That doesn’t sound very pleasant, does it? But the good news is that it all ends the day your babies are born (well, not the sleeping part). Don’t be shy about using a wheelchair when you’re out with the family at say, the zoo, or motorized shopping cart when at the store.

The second trimester is when, as your pregnancy progresses you put on more weight, your pregnancy hormone sky rockets and you’re pregnancy symptoms just appear worse!

The third trimester is really hard on women carrying twins. Be under no illusion. And as for a triplet pregnancy, which are becoming more popular with assisted reproductive technologies, well lets just say singleton moms have a walk in the park in comparison!

No one will mind! To prevent mild edema to your feet, try compression stockings. And when someone asks you when you’re due for the tenth time in a day, just smile and say, “Not soon enough.”

The National Institute for Health and Care Excellence advise that in twin pregnancies, women should be offered additional antenatal visits because of the higher risk of complications of multiple births.

Sex during pregnancy won’t trigger preterm labor

Depending on how you’re feeling physically, this may or may not be good news! According to recent research, sex won’t bring on preterm labor. So enjoy an intimate evening with your man. The trick, of course, is finding a comfortable position!

The risk of premature birth is normal for twin pregnancies compared to singleton pregnancies. Vaginal delivery is more than possible but expect a cesarean as a vaginal birth only happens in about one third of twin pregnancies. Read our guide to sex in pregnancy with twins.

Breastfeeding your newborns will save you thousands of dollars (and it’s good for the environment, too)

Did you know that the percentage of moms who breastfeed their twins is way, way less than moms of singletons? It shouldn’t come as a surprise since there is a larger learning curve to breastfeeding more than one. Furthermore, new moms to twins often feel overwhelmed after the birth of their babies and bottle feeding allows others to pitch in. 

But if you do your research now, you’ll reap the benefits later as breastfed babies drink for free (bottle-fed babies eat up about $3,500 a year). Read our guide on saving money whilst raising twins.

If you’re planning on breastfeeding, read up on the subject before the babies arrive (a good book to get is Mothering Multiples: Breastfeeding & Caring for Twins or More), invest in a breastfeeding pillow such as Twin-Nursing-Pillow, get a few referrals for a licensed lactation consultant, and try to attend a La Leche meeting to connect with other breastfeeding moms.

It will take about a year for your body to fully recover after a twin pregnancy

Give yourself a break and don’t hop on the scale or stare at your sagging stomach or “twin skin.” You just gave birth to twins, for goodness sake. Cut yourself some slack! Eat sensibly once the twins arrive and the pounds will slowly creep off.

Once your doctor gives you the OK to exercise instead of hitting the gym, hit the pavement with a baby stroller with an eye towards a hilly neighborhood. Walking briskly for an hour while pushing that double stroller burns about 220 calories!

Your Twin Pregnancy Is Worth ALL the Effort and Work

Your advice is exactly what pregnant twin mamas need to know. I especially agree with asking for help from friends and family. I am grateful for the meals delivered by my best friend and sister, the laundry done by grandma, the gardening done by my sister, and the walks grandpa took with the boys in the stroller.

My obstetrician told me that anyone who enters your house is either doing dishes, laundry or cooking. Don’t worry, it does get easier for parents of twins.

He was so right.

Good luck mama!