Ask Dr. K: Pregnancy with twins can be challenging

DEAR DOCTOR K: I just found out I’m pregnant with twins. How will this pregnancy be different from my last one?

DEAR READER: In the United States, twins occur in one out of every 35 births. A multiple pregnancy differs from a singleton pregnancy in several ways. For example:

• Pregnancy symptoms, such as morning sickness and breast enlargement, may be more severe.

• You’ll gain a substantial amount of weight. Pregnancy is the one time in most women’s life that a doctor suggests that they gain weight. You’ll be advised to gain between 35 and 45 pounds if your weight was in the normal range to start with.

• Symptoms of later pregnancy may occur earlier and be more severe. Your heavy, stretched uterus will place pressure on your organs. This may cause fatigue, shortness of breath, heartburn, constipation, pelvic discomfort, urinary leakage, back pain and hemorrhoids.

• Complications are more common. These include pre-term labor, premature rupture of the amniotic membranes, pre-eclampsia, placenta previa, prolonged labor and newborn problems.

• You’ll have a higher chance of premature delivery. Many twins are born at 37 to 38 weeks of gestation.

• Twins are more likely to be born with low birth weight (less than 5.5 pounds).

• You’ll be at increased risk for developing anemia due to deficiencies of iron and certain vitamins.

Your doctor will use ultrasound throughout your pregnancy to monitor the growth and development of the fetuses. Ideally, both babies should have similar growth and weight gain.

Ultrasound also provides valuable information about the position of the fetuses. This information is especially important at the time of delivery. It can help determine whether it will be safest for you to deliver vaginally or by cesarean section.

So this pregnancy may well be somewhat more challenging than previous pregnancies. But you’ll have two wonderful children.