Week 21 - Pregnant with Multiples

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Hello. This is Dr. Mauldin. I hope you are doing well this week.

So… you’re 21 weeks pregnant….That is great news. If I had to guess, I bet you are feeling pretty good right now.
For most patients, they’ve passed the stage of just feeling bloated. Their appetite is in full swing, their energy has returned and the most fun part is that you are beginning to feel your baby move! At first, the movements are going to be quick – like little flutters – that you probably only feel when you are sitting quietly. But over the next few weeks, you’ll begin to feel kicks and rolls throughout the day. Eventually, you’re going to feel that the baby is keeping you up at night because he or she moves so much then!

Since you recently had an ultrasound, some of you may have found out that you were having twins.  If so, you will need some special attention during your pregnancy. Because you will be carrying more than one baby, it is even more important that you eat well and pay attention to your weight gain – because having more than one baby means that you will need to gain more weight. For an average sized woman, this means eating about 2,700 calories/day – rather than the typical 2000 calories/day. Also – these extra calories should really be nutrient dense foods and include extra portions of lean proteins. In addition to a prenatal vitamin, your physician may also recommend that you take some additional vitamins and minerals to help your babies grow and your uterus to stay relaxed.

If you are pregnant with twins, you will tire more quickly than the rest of us that are pregnant. Your uterus will grow larger more quickly and around 30 weeks or so – your uterus will be about the size of a term pregnancy. Do rest as much as you can – to help keep your energy up.

The risk of some complications is higher among twin pregnancies. Let’s go over those now:

One of those is Anemia - which means having a low blood count. This would be treated with extra iron and perhaps some extra folate.

Hypertension may also occur. This would present as preeclampsia, which is a condition during pregnancy where a patient’s blood pressure increases and there is more protein in the urine. Having preeclampsia could possibly decrease the amount of blood flow to the uterus, the placenta and the babies.

Gestational diabetes is more common among moms with twins. If you develop diabetes, your healthcare provider will recommend using either a pill or an insulin injection to control your blood sugars. Did you know that the better your blood sugars are controlled during pregnancy – the less likely you will have a baby that is too big? So, we really like to stress the importance of blood sugar control among our patients.

Another possible complication is preterm labor. Because prematurity can be very serious for the babies, if you ever think you are contracting or have persistent lower back pain, call your doctor and discuss your symptoms with them.

One last thing I should say is that twins are more likely to be smaller than average.  Twins will typically grow as expected until about 30 weeks, then their growth will slow down.  Ultrasound will be used regularly to monitor your babies’ growth to make sure they are still growing appropriately and are benefiting from the intrauterine environment.

Stay healthy – and I’ll talk to you next week.

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