Your Twin Pregnancy: Week 22 to 24

  • By: Sandra
  • Date: March 18, 2022
  • Time to read: 4 min.

By Week 22, you’re still in the honeymoon stage of your twin pregnancy—you’re far enough along where you can now feel your babies kicking on a daily basis (one of the best perks of pregnancy!) and moving about is still relatively easy.

Beginning to Get Uncomfortable

As you gain some serious weight in the coming weeks, it will become more uncomfortable to walk or stand for any length of time. So enjoy this phase now as it’s a definite “sweet spot” in your twin pregnancy. (Maybe take this time to go shopping for your double stroller!)

Although you’re feeling pretty darn good, you’re also entering what I call, “the danger zone,” the point in a twin pregnancy where many complications may begin to surface. Yes, I hate to be the bearer of bad news, and no, I’m not trying to scare you.

Rather I’m trying to give you information to empower you! Below are several complications that are more prevalent to women carrying multiples. Read each one, memorize their signs and symptoms so you know what to be on the look out for and then move on with your life. (And can I add, “try not to worry,” even though I know you will?)


Know the signs of preeclampsia. Preeclampsia is a serious pregnancy condition marked by a rapid rise in blood pressure combined with excessive protein in the urine. Although moms expecting singletons run a five to eight percent risk of developing the condition, women pregnant with twins have a 25 to 30 percent chance.

A substantial increase to be sure! Preeclampsia usually occurs sometime after Week 20 and if left untreated it could lead to potentially fatal eclampsia. (Fans of the hit series, Downton Abbey, will remember that a beloved character, Lady Sybil, died of the condition just hours after giving birth.)

The good news is that if caught early (as it often is), moms can go on to deliver healthy babies and recover fully. But the signs of preeclampsia are often subtle. Many moms dismiss the symptoms, thinking they’re just a part of general pregnancy discomfort. But not you! You listen to your body, and will call your doctor immediately if you have any of the following symptoms, right?

  • Hands, feet, and especially face and ankles become excessively puffy.
  • A headache that just won’t go away.
  • A change in eyesight: blurry vision including seeing “spots,” and a sensitivity to light.
  • Nausea or vomiting.
  • Abdominal pain in the upper right corner of chest, similar to heartburn. Or, unexplained shoulder pain.
  • Shortness of breath, rapid heartbeat, or a general feeling of confusion.
  • Rapid weight gain of nearly a pound or more per day.

Although the cause of preeclampsia is unknown, you can limit your risk by keeping all prenatal appointments where your blood pressure will be monitored closely.

Furthermore, studies suggest that foods high in fiber and/or calcium may help reduce your risk. And finally, stay away from processed foods that are often high in sodium, a contributing factor to hypertension.

Gestational Diabetes

When you’re pregnant, your body becomes slightly more resistant to insulin, the hormone that helps transport sugar from your bloodstream to your cells where it is used for energy.

Gestational diabetes occurs when there’s too much sugar or glucose in your blood.  Although the condition affects only five to 10 percent of moms carrying singletons, moms with multiples are at a much greater risk.

Furthermore, your risk increases if you are over the age of 30, were overweight at the start of your pregnancy, or have a family history of the condition. If left untreated, gestational diabetes can lead to a preterm birth.

Your babies will be at a higher risk for obesity and type-2 diabetes later in life (although studies have shown that breast-feeding your babies will reduce this risk). Your doctor will screen for glucose in your urine with every prenatal visit, and then order a glucose tolerance test around Week 24 as you’re especially vulnerable to the condition from mid-pregnancy on.

The good news? Gestational diabetes is highly treatable through diet (i.e. cutting out carbohydrates and concentrating on lean protein). And once your babies are born, your glucose levels should return to normal.

Preterm Labor

The biggest worry for moms expecting twins—by far—is the fear of going into labor before their due date. (By definition, preterm labor occurs prior to Week 37.) And the fear is real as approximately only 40 percent of women carrying twins make it to Week 37.

Yet did you know that if labor is caught in time (translation: the cervix has not dilated past two centimeters and the amniotic sacs have not ruptured) labor can be successfully stopped with medication?

The key is to know the signs of preterm labor and alert your doctor immediately. Yet the beginning signs of labor are often subtle, leaving many moms-to-be scratching their heads, wondering, “Am I really going into labor?”

Your best defense? Educate yourself on the signs of preterm labor and do not hesitate to call your doctor if you think you may be in labor. If you experience any of the symptoms below, call your doctor. You will not be bothering her; she will not think that you are overreacting. Just call her.

  • Menstrual-like cramps with or without diarrhea.
  • Upset stomach or vomiting.
  • Six or more contractions per hour. Or, contractions that increase in frequency.
  • Strong pelvic pressure.
  • A dull, low backache.
  • Or, pain radiating from your upper thighs.
  • Change in vaginal discharge, especially if it is bloody or watery.
  • Just an innate sense that “something isn’t right.”

Now that you know the signs and symptoms of preeclampsia, gestational diabetes, and preterm labor, you’re good to go. It’s all going to be OK. Just be vigilant and never hesitate to call your doctor with questions or concerns. That’s what you pay her the big bucks for.