Special Considerations


Multiples are both exciting and challenging. During pregnancy there can be a lot more complications and therefore you need to be watched more closely than the typical pregnancy. You do not necessarily need to see a high risk doctor but a doctor with experience with multiples.

  • Pregnant women with multiples are at higher risk for:
  • Preterm labor (typical delivery for twins is 36 weeks, triplets 32 weeks)
    Gestational diabetes
    Hypertension (elevated blood pressure)
    Growth restriction of one or more babies

  • Some things to think about:
  • Most of the time women with multiples should expect to be on bed rest sometime in their pregnancy, usually by 32 weeks
    Often deliver early
    May have to have a C-section due to baby position
    You will need to be seen weekly beginning at 28 weeks

    High Blood Pressure

    High blood pressure in pregnancy can be particularly dangerous as it can lead to less blood flow through the placenta. This can decrease the nutrients and oxygen going to the baby. There are different types of hypertension (elevated blood pressure in pregnancy)

  • Gestational Hypertension
  • Hypertension did not exist before pregnancy. There are no other symptoms associated with the high blood pressure. It usually resolves after pregnancy.

  • Preeclampsia
  • Hypertension that leads to stress on the mom’s body. Symptoms of preeclampsia include headaches, blurry vision, pain in your upper belly, severe swelling in ankles, and rapid weight gain. Preeclampsia that becomes severe can lead to eclampsia or seizures.
    If you are diagnosed with hypertension in pregnancy, you will be seen more often with testing of the baby. You may also be delivered early because of the high blood pressure.
    You can work with your doctor by checking your blood pressure daily and reporting high readings, lowering your salt intake, maintaining exercise and a proper diet, decreasing your stress at home and at work, taking any blood pressure med as prescribed, and if you are put on bed rest make sure you remain at home.

    If you have any questions, contact your Doctor.

    Gestational Diabetes

    Gestational Diabetes is diabetes that arises during pregnancy. It is not present before pregnancy. It causes high levels of glucose (sugar) in the blood of the pregnant woman because the insulin in her body is not converting sugar to energy. The placenta can change the way insulin works and make it less effective causing high sugar levels.

  • This may lead to:
  • Birth defects such as heart, spine, or kidney defects
    Macrosomia or a big baby that makes delivery difficult
    Preeclampsia or high blood pressure
    Polyhydramnios or high levels of amniotic fluid
    Lungs in the baby that are not developed

    If you have gestational diabetes you will need to change your diet and increase your exercise. You may need to be on medications such as oral medications or insulin injections if you can’t control your blood sugars with diet alone. You will have to check your blood sugars several times a day and report them to your doctor. The baby will be monitored closely with weekly visits in your last trimester.

    For additional resources, please contact:
    Boone Hospital Center’s Wellaware Diabetes Self-Management Program
    1601 E Broadway
    Columbia, MO 65201-8020
    (573) 815-3870