Pregnancies With Multiples and The Importance of Pediatricians and Neonatologists

Multiple pregnancies - where one woman gives birth to more than one baby – have been increasing in recent years, mostly due to the increased numbers of women receiving artificial fertility treatments. In fact, since 1980, the rate of twins or multiple births has increased 70% in the United States! That’s a large jump – from 1.25% to 3.2% of all births. Despite the fact that parents now have more options than ever to conceive children despite advancing age or physical inability to do so, there are some risks associated with assisted reproduction. Pediatricians and neonatal specialists must be closely involved in pregnancies that involve multiples, and some of the more challenging parts of pediatrics jobs may occur when dealing with these situations.

First of all, multiple fetuses (which may or may not have separate amniotic sacs) can cause a higher risk of IUGR (intrauterine growth restriction), especially after the 32nd week of pregnancy when the fetuses have increased in size. As is logical, the larger the fetuses and the more of them there are, the less space is available to each. This can affect the amount of oxygen and nourishment that each receives. In instances where two placentas develop, it often occurs that one implants in a more optimal place than the other, causing one fetus to develop more fully and have a larger birth weight when compared to the other. If a defect is found in one twin (via ultrasound), the other twin should be examined carefully to look for a similar problem. The rate of malformations (birth defects) is higher in identical twins, but sometimes only one is affected.

The total time a woman is pregnant also varies according to how many fetuses she is carrying – not surprisingly, for single births, the average delivery time is at 38.8 weeks, whereas for twins, it’s only 3.5 weeks. Triplets have an even shorter average gestation – 32.2 weeks, while quadruplets, only 29.9 weeks. Premature birth, though it may be necessary due to the growing size of the fetuses, also brings its own risks to the mother as well as to the infants. For instance, rates of cerebral palsy are higher in multiple births, and a whole host of additional problems can occur when infants are born too small. They may require treatment in the neonatal intensive care unit, or have additional difficulties feeding or breathing on their own.

Finally, the mother herself incurs additional risks due to pregnancy with multiples. She has a greater risk for pregnancy-induced hypertension, prolapsed umbilical cord, or premature rupture of her membranes. The extra weight of carrying multiples is an additional burden on the woman, who may have more difficulty staying active late into her pregnancy. Back and joint problems can also occur, especially with three or more fetuses. The emotional and mental toll of caring for multiples is another factor to consider – mothers and fathers face all the challenges of regular infant care times three or more. Just feeding and changing all of the babies can be exhausting, let alone the other tasks inherent to caring for young babies.

In today’s extremely advanced medical climate, most of us take the pregnancies often highlighted in the media for granted without realizing that there are real risks to the health and well-being of the infants as well as the mother. Multiple pregnancies can turn out well, but this isn’t always the case – many infants die from complications or suffer lifelong impairments from having been born prematurely. Pediatricians and neonatologists continue to expand their skills and knowledge, so even the tiniest babies have a better chance today than they did just a decade ago. Still, it’s best for all parents considering assisted reproduction to consult a pediatrician and neonatologist as soon as they consider the possibility of multiples. Mothers who discover that they are naturally expecting twins can also benefit from the early input and advice of a qualified pediatrician and neonatal expert.