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High blood pressure is a common occurrence in multiple pregnancy. Sometimes it pre-dates the pregnancy, other times it develops during the course of pregnancy. Women with more than one fetus are more likely to develop hypertension. Your doctor may recommend low-dose baby aspirin from early pregnancy to help prevent this.

Both older and younger mothers and those with pre-existing hypertension or kidney disease are more likely to develop a particular type of hypertensive disorder called pre-eclampsia, which can affect many maternal systems and the placenta. This disease is often manifested by protein in the urine and edema (swelling) in the lower extremities (legs). In more severe forms, abnormalities in blood work can arise, particularly low platelets and a rise in the liver enzymes.

Although it usually presents in late pregnancy, more severe forms of the disease can manifest earlier and lead to fetal consequences, such as intrauterine growth restriction. At each antenatal visit in the second and third trimesters, your doctor will monitor your blood pressure and test your urine to rule out one of these disorders.

Mild form of this disease can often be managed medically to attempt to gain additional gestational age for the babies. Severe cases, where the blood pressure cannot be controlled, when serious abnormalities are found in the blood work or where fetal compromise is present, require early delivery. Delivery is the only cure for this disease. Twin pregnancies complicated by hypertension are more likely to require emergency caesarean section delivery, and the babies have higher rates of admission to NICU.

Twin pregnancies have a two-fold increased risk of developing gestational diabetes (GDM) compared to singletons. Rates of admission to NICU and longer hospitalizations tend to be higher in twins when the mother has GDM, compared to non-diabetic mothers of twins. The cause of increased rates of GDM can be many; older mothers, use of assisted reproductive techniques, larger or multiple placentas that produce hormones that oppose the body’s own insulin. The more babies in the uterus, the higher the risk of GDM.

All pregnant mothers are offered screening for gestational diabetes, usually between 24 and 28 weeks of pregnancy (see section on The Journey, second trimester). Depending on your obstetrical and medical history, you may be offered earlier screening if you are carrying a multiple pregnancy. Patients with a positive screening test for GDM will be offered a confirmatory test. If GDM is confirmed, you will be referred to the Obstetric Medicine Clinic where medical internists and nurse educators will teach you about the disease and closely monitor you during treatment to optimize control of your blood sugar and minimize problems for newborns. Management of GDM may include a special diet or insulin if diet alone isn’t enough. Following delivery your babies will have early assessment of their blood sugars and if low, early feeding is advised. Fortunately, following delivery GDM usually resolves without incident, however mothers with GDM are more prone to develop type 2 diabetes later in life.

During a multiple pregnancy, several symptoms that might arise are troublesome to expectant mothers but are not medically worrisome. Nevertheless, they can interfere with your daily activities, and are especially aggravated in the second and third trimesters. Most are related to the mechanical change of your rapidly expanding uterus. Symptoms may include but are not limited to:

• Nausea and vomiting
• Heartburn
• Numbness and pain in the hands (carpal tunnel syndrome)
• Sore hips and joints
• Itching
• Anemia