Getting pregnant with twins is simultaneously a double blessing and double trouble. While twin pregnancies most often result in a healthy if not harried mom and two delightful babies, they can also be riskier than singleton pregnancies.

Twin or triplet pregnancies occur in approximately 3% of births, and that number may be increasing. While assisted reproductive techniques certainly increase the risk of twin pregnancies, spontaneous twin pregnancies also become more common as women near their late 30s. Generally, parents get the surprise that they are having twins at their first ultrasound, whether it is done in the first trimester or at 20 weeks. The ultrasound will show whether or not the twins share the same amniotic sac or placenta. Twins that share the same sac or placenta have a higher risk of developing twin-twin transfusion syndrome, which can increase the risk of health problems developing in both babies.

Twin pregnancies also place moms at higher risk of pregnancy complications, such as gestational diabetes and preeclampsia. Routine screening for twin pregnancies therefore may include a greater frequency of visits, as well as regular ultrasounds to monitor maternal and fetal health more closely. Moms who are pregnant with twins should also be aware of the increased risk of preterm labor and subsequent preterm birth. Although most twin pregnancies will reach 36-37 weeks, twin moms should be prepared for the possibility of bed rest or, at the very least, decreasing activity. This may happen naturally as it becomes more difficult to move around with the increased back pain, shortness of breath, sleep disturbances and anemia that occurs with twin pregnancies.

The nutritional requirements for twin pregnancies are different than for singleton pregnancies. We recommend that mothers of twins take in additional folic acid, calcium and iron. Growing two healthy babies also requires additional calories, as well as increased weight gain–up to 10 to 20 more pounds than a singleton pregnancy. There is some variation in nutritional recommendations, though, so discuss this with your provider.

Twins can often be delivered vaginally, but the risk of a cesarean section can be higher. Sometimes a cesarean section is planned ahead of time, depending on the circumstance. Be sure to talk to your provider about the delivery plan with a twin pregnancy.

While having a twin pregnancy can seem overwhelming and a bit more involved than having a singleton, being aware of complications and catching them early is one way to help lessen their impact. Keep in mind that most twin pregnancies end with a good outcome: a healthy mom and two healthy babies.