Risks in twin pregnancy

LAST week, social media was abuzz with the news of Beyonce and her twin pregnancy. Not only did the news elicit millions of congratulatory messages to Beyoncé and her husband Jay Z, it also renewed interest in the topic of twin pregnancy among Malaysians.

An announcer with a local English radio station who was talking about Beyoncé’s expected twins shared that he wished his wife would have a twin pregnancy too as it would result in two babies for the price or hassle of one pregnancy. He also described the twin babies he’d seen in the public as cute, adorable and desirable, especially when they were dressed in similar outfits.

I also came upon an article where a reader asked the medical writer of a newspaper how she could increase her chances of conceiving twins.

Being in the profession of caring for pregnant mothers, and for someone who sees many problematic twin pregnancies, let me just say that I hear this request quite often. Many couples believe that having a twin pregnancy is like a “two-in-one deal”. For them, it would seem to save a lot of their time, money and hassle to get two or even three babies with one pregnancy.

Twin pregnancy looks desirable to the public because most of the time what they see are the successful outcomes. What they don’t see are the complications associated with twin pregnancy, which doctors, nurses and the families of the pregnant patients undergo.

For those who still yearn for a twin pregnancy and are considering on increasing their chance of having it through artificial reproductive techniques or some unproven advice on diet or sexual activities, please allow me to advise you of a few complications of twin pregnancy that you must be aware of.

The most common and feared complication of a twin pregnancy is pre-term delivery and small babies. Only about 40% of twin pregnancies will reach full term compared to 90% in single pregnancies. Most women with twin pregnancy will deliver before 36 weeks of gestation. If they are born too soon, the babies can suffer the complications of prematurity which include respiratory distress, infection, prolonged stay in the neonatal intensive care unit, cerebral palsy and even death.

The following are the risks:

> Higher chance of a miscarriage compared to a single pregnancy;

> Higher risk of suffering exaggerated pregnancy symptoms such as nausea, vomiting, lethargy, body aches and etc;

> Higher risk of conceiving abnormal babies;

> Higher risk of getting medical diseases such as gestational diabetes and hypertension;

> Higher risk of getting placental problems such as placenta previa (placenta in the lower part of the womb) and abruptio placentae (bleeding under the surface of the placenta), which can be life threatening to the babies;

> Higher risk of delivering via Caesarean section;

> Higher risk of developing post delivery bleeding; and

> Risk of getting unique complications of twin pregnancy such as twin to twin transfusion syndrome (TTTS), conjoint twins and twin reversed arterial perfusion (TRAP) syndrome which all have a high mortality rate.

All in all, the perinatal mortality and morbidity (chance of a baby dying or having an adverse outcome either during pregnancy or within the first week post delivery) is higher for a multiple pregnancy compared to a single pregnancy. The complications rate is at a much higher rate for triplets and higher order pregnancy.

It is not my intention to cause alarm among pregnant women who are carrying twins but rather to educate the general public about the lesser talked about issues of twin pregnancy. For those who are already expecting twins or who will be having a twin pregnancy, please remember that your pregnancy is considered a high risk pregnancy and hence it should be managed as such.

Also remember that with good obstetric care from your doctors and nurses, an optimal outcome can be achieved for the twins and the mother.

DR JRP

Ipoh