Pregnant with Twins: How to Stay Healthy

Finding out you're expecting twins brings a rush of emotions—excitement, wonder, and probably some anxiety about what lies ahead. Twin pregnancies are more complex than singleton pregnancies, requiring additional monitoring, nutrition adjustments, and awareness of certain risks. But with good prenatal care and attention to your health, most twin pregnancies result in healthy babies and healthy moms.

Types of Twin Pregnancies ACOG

Understanding your type of twin pregnancy helps you know what to expect:

Identical (Monozygotic) Twins:

• One egg splits into two embryos
• Always the same sex
• Share same genetic material
• May share a placenta (monochorionic) or have separate placentas (dichorionic)
• If sharing a placenta, require closer monitoring

Fraternal (Dizygotic) Twins:

• Two separate eggs fertilized by two sperm
• May be same or different sex
• Genetically as similar as any siblings
• Always have separate placentas (dichorionic)

Why the placenta situation matters:

• Twins sharing a placenta (monochorionic) need more frequent monitoring
• Risk of twin-to-twin transfusion syndrome (TTTS)
• Different growth rates may occur
• Your doctor will determine your type through early ultrasound

Prenatal Care for Twin Pregnancies ACOG

Twin pregnancies require more frequent monitoring than singleton pregnancies.

More frequent appointments:

• You'll see your provider more often
• Additional ultrasounds to monitor growth
• More frequent blood pressure and urine checks
• Possible referral to maternal-fetal medicine specialist (perinatologist)

What they're monitoring:

• Growth of both babies (ensuring similar rates)
• Amniotic fluid levels for each baby
• Placenta function
• Signs of preterm labor
• Your blood pressure and overall health
• Gestational diabetes risk

Specialized tests you may need:

• More detailed anatomy ultrasounds
• Non-stress tests in later pregnancy
• Biophysical profiles
• Cervical length measurements

Nutrition: Eating for Three AAP

Growing two babies requires significantly more nutrients than a singleton pregnancy.

Caloric needs:

• About 600 extra calories per day (compared to pre-pregnancy)
• This is roughly 300 more calories than a singleton pregnancy
• Focus on nutrient-dense foods, not empty calories
• Weight gain recommendations are higher for twin pregnancies

Expected weight gain (depends on pre-pregnancy weight):

• Normal BMI: 37-54 pounds
• Overweight BMI: 31-50 pounds
• Obese BMI: 25-42 pounds
• These ranges are higher than singleton recommendations

Key nutrients to prioritize:

• Protein: 100-150 grams daily (meat, fish, eggs, beans, dairy)
• Iron: Higher needs—your provider may prescribe supplements
• Calcium: 1,500-2,500 mg daily (dairy, fortified foods, supplements)
• Folic acid: Continue prenatal vitamins throughout pregnancy
• DHA: Important for brain development (fish, supplements)

Eating strategies:

• Small, frequent meals (your stomach will be compressed)
• Protein at every meal and snack
• Stay well-hydrated
• Healthy snacks within reach at all times
• If nauseous, eat what you can tolerate—something is better than nothing

Common Discomforts (and What Helps)

Twin pregnancies often bring more intense versions of typical pregnancy discomforts:

Morning sickness:

• Often more severe in twin pregnancies
• Higher hormone levels are the culprit
• Usually improves by second trimester
• Talk to your doctor if you can't keep food/fluids down

Fatigue:

• Extreme tiredness is very common
• Rest whenever possible
• Accept help with daily tasks
• Listen to your body—this is demanding work

Back pain and body aches:

• Your body is carrying significantly more weight
• Pregnancy support belts may help
• Prenatal massage (with trained therapist)
• Good posture and supportive shoes
• Swimming or water exercises

Shortness of breath:

• Two babies take up more space
• Your diaphragm gets compressed
• Sleep propped up on pillows
• Take breaks during activity
• Report severe breathlessness to your doctor

Heartburn and indigestion:

• Very common with twins (compressed stomach)
• Small, frequent meals
• Avoid lying down after eating
• Sleep elevated
• Talk to doctor about safe antacids

Swelling:

• Some swelling is normal
• Elevate feet when possible
• Stay hydrated (counterintuitive but helps)
• Report sudden or severe swelling—could indicate preeclampsia

Potential Complications to Know About ACOG

Twin pregnancies carry higher risks for certain complications. Knowing the signs helps you get prompt care:

Preterm labor:

• About 60% of twins are born before 37 weeks
• Learn the signs: regular contractions, pelvic pressure, low back pain, vaginal discharge changes
• Contact your provider immediately if you experience these
• You may be advised to reduce activity or go on bed rest

Preeclampsia:

• High blood pressure condition unique to pregnancy
• More common in twin pregnancies
• Signs: severe headache, vision changes, upper abdominal pain, sudden swelling
• Requires immediate medical attention

Gestational diabetes:

• Higher risk with twins
• Screened for around 24-28 weeks
• Manageable with diet, exercise, sometimes medication
• Important to control for baby health

Twin-to-twin transfusion syndrome (TTTS):

• Only affects identical twins sharing a placenta
• Unequal blood flow between twins
• Monitored through ultrasound
• Treatment available if detected

Intrauterine growth restriction (IUGR):

• One or both twins growing more slowly than expected
• Common in twin pregnancies
• Monitored closely through ultrasound
• May affect delivery timing

Activity and Rest ACOG

Recommendations vary based on your specific pregnancy, but general guidelines:

First and early second trimester:

• Usually can maintain normal activities
• Continue exercise if you were active before
• Modify intensity as needed
• Stay hydrated

Later pregnancy:

• Most providers recommend reducing activity
• Avoid high-impact exercise
• Walking and swimming often still okay
• Follow your provider's specific recommendations

When to stop and rest:

• Contractions or cramping
• Vaginal bleeding
• Fluid leaking
• Feeling faint or dizzy
• Baby movement significantly decreasing

Work considerations:

• Many women with twins stop working earlier
• Discuss with your provider based on your job demands
• Standing jobs may need modifications sooner
• Plan for earlier leave if possible

Preparing for Delivery

Twin deliveries require additional planning and often happen earlier than singleton births.

When to expect delivery:

• Full-term for twins is considered 37-38 weeks
• Many twins arrive between 34-37 weeks
• Your provider will discuss optimal timing based on your situation
• Delivery may be scheduled if babies or mom develop complications

Vaginal vs. cesarean delivery:

• Vaginal delivery is possible for many twins
• Position of Baby A (the one closest to exit) matters most
• If Baby A is head-down, vaginal birth may be attempted
• Some situations require cesarean
• Be prepared for either possibility

Hospital considerations:

• You'll deliver at a hospital equipped for twins (most are)
• NICU availability is important
• More staff will be present at delivery
• Be prepared for longer hospital stay

Preparing at Home

Getting ready for two babies takes extra planning:

Essentials to double:

• Car seats (required to leave hospital)
• Safe sleep spaces
• Feeding supplies
• Diapers (so many diapers)

Where you can share:

• Stroller (get a good double stroller)
• Play mat/activity gym
• Bathtub
• Changing supplies

Support system:

• Line up help for after birth—you'll need it
• Accept every offer of meals, cleaning, etc.
• Consider night help if possible (even occasionally)
• Connect with other twin parents (invaluable support)

Practical preparations:

• Meal prep and freeze before birth
• Stock up on household supplies
• Arrange pet care/childcare for older kids for delivery
• Pack hospital bag earlier (around 30-32 weeks)

Mental Health Matters

The emotional demands of a twin pregnancy (and the newborn period) are significant.

What's normal to feel:

• Overwhelmed by the reality of two babies
• Anxious about complications or preterm birth
• Excited and terrified at the same time
• Worried about finances, space, capabilities
• Sad about loss of simpler singleton experience

What helps:

• Connect with other twin parents
• Talk openly with your partner about fears
• Discuss concerns with your healthcare provider
• Consider therapy if anxiety becomes overwhelming
• Prepare as much as you can (reduces anxiety)

The Bottom Line

Twin pregnancies require extra attention, nutrition, and monitoring—but they also bring double the joy. Stay connected with your healthcare team, listen to your body, and don't hesitate to reach out when something doesn't feel right.

The best things you can do: attend all prenatal appointments, eat well, rest when you can, know the warning signs of complications, and prepare for an earlier arrival than a typical pregnancy.

Clara is here to support you through your twin pregnancy journey and answer questions along the way.