Many couples, especially the ones undergoing infertility treatments, are overjoyed when they find out they are pregnant with not just one but two or three babies. While the excitement and joy double, risks and complications increase too. Why are most twins or triplets born with low birth weight? Should you worry about it?
A baby’s birth weight is very important and a determining factor in the baby’s future health and development. Many babies are born underweight or overweight. While not all babies are impacted by their birthweight, some babies face some consequences or need medical intervention.
Low birth weight, though common, is not to be taken lightly. Low birth weight carries the risk of the baby developing breathing issues, health complications, and difficulty staying warm, feeding, and gaining weight as expected. It also increases the long-term risk of developing type 2 diabetes, heart conditions, or high blood pressure. Extremely low birth weight increases the risk of neonatal and fetal mortality.
In pregnancy, if more than one baby is developing in the uterus, it is known as a multiple pregnancy. This can be twins, triplets, or more. Multiple pregnancy is more common among women conceiving through fertility treatments.
Multiple pregnancy can be two or more separate eggs fertilised by separate sperm, or a single fertilised egg, split into two or more embryos. In fertility treatments, if the maternal age is higher, more than one embryo is transferred to increase the chances of pregnancy. This increases the possibilities of multiple pregnancies. Multiple pregnancy can happen through natural conception, too.
In multiple pregnancies, the babies are more often of low birth weight. Some common reasons are –
1. Premature Birth - Babies are considered premature at birth if born before 37 weeks. Babies gain maximum weight in the last few weeks of pregnancy. Premature babies are often born with low birth weight because they miss the final weeks of growth in the womb.
2. Limited Space – Where one baby has to grow, two or more babies grow. The uterus expands with pregnancy, but it cannot stretch beyond a point. The lack of space limits the babies’ growth and weight gain.
3. Shared Nutrients – Though an expecting mother eats more than usual, she cannot eat enough to meet the nutritional requirements for multiple babies. As a result, twins and triplets receive fewer nutrients than single babies, limiting their weight gain.
4. Placental Insufficiency – Placental insufficiency is when the placenta is unable to meet the needs of the fetus. With multiple fetuses to provide for, the placenta may not supply enough nutrients and oxygen required for healthy development. This, in turn, can restrict growth and weight gain.
5. Twin-to-Twin Transfusion Syndrome – When identical twins share a placenta, the blood flow between them may become unbalanced. As a result, one baby may receive more blood and nutrients and grow larger, while the other may receive less and remain smaller.
6. Preeclampsia – Preeclampsia is a serious pregnancy complication where the mother’s blood pressure is too high. High blood pressure can restrict blood flow to the placenta, thereby affecting the growth and weight gain of babies.
7. Mother’s Health – Maternal health plays a vital role in the development and weight gain of the babies. In the case of health issues, unhealthy lifestyle, poor diet, exposure to substances, etc., the risk of low birth weight is higher.
Low birth weight carries several risks, classified as short-term and long-term.
● Development of breathing issues
● Jaundice due to an underdeveloped liver
● Low blood sugar
● Infections due to low immunity
● Gastrointestinal issues
● Inability to regulate body temperature
● Feeding issues
● Delay in development
● Learning disabilities
● Intellectual disability
● Cerebral palsy
● Increases risk of chronic health issues
● High blood pressure later in life
● Development of obesity
● Vision and hearing issues.
In the case of low birth weight in multiple births, parents should be aware of the following –
1. Close Monitoring – Your babies will require close monitoring and specialised care in the NICU (Neonatal Intensive Care Unit). The duration of their stay in the NICU will vary depending on complications, developmental progress, and their ability to cope with the new environment. The doctors and nurses will keep a close watch to ensure any danger signs or complications are addressed at the earliest.
2. Temperature Control – Your babies may still struggle with temperature control. They will be kept in special temperature-controlled beds to ensure they are warm at all times.
3. Specialised Feeding – Due to low birth weight, they require regular feeding. If they were born premature or are unable to suck properly, they may be fed through IV or a feeding tube reaching their stomach.
4. Kangaroo Care – Skin-to-Skin contact can support overall development and temperature regulation. It can help establish breastfeeding. Both the mother and the father can offer kangaroo care to the babies.
5. Manage Complications – The doctors will evaluate the babies and check for complications. Early identification and treatment of complications such as low blood sugar or gastrointestinal issues can help prevent long-term consequences. This means your babies may require regular blood and other tests.
If you are pregnant with more than one baby, you can do the following to reduce the risk of low birth weight and other complications associated with multiple pregnancy –
● Focus on Nutrition – During pregnancy, the expectant mother must focus on a nutritious diet. Yes, cravings are a part of pregnancy, but that should not stop you from eating healthy and ensuring you get sufficient quantities of all essential nutrients.
● Attend prenatal Checkups – Don’t miss any prenatal checkups and tests. They help monitor the progress of pregnancy and fetal development. Identifying growth or weight gain issues at the earliest can help the doctors come up with alternative suggestions.
● Increase Calorie Intake – With more than one baby depending on you for nutrition, you need to increase your calorie intake. You cannot increase intake instantly. Slowly increase your intake and ensure you consume more nutritious foods, not unhealthy or sugary foods.
● Hydration – Your body requires more hydration to make all that extra blood. Ensure you drink plenty of water or fresh juices without added sugars. You can even add some lime slices, cucumber, or other fruits to your water if plain water seems boring.
● Don’t Worry About Weight Gain – One of the biggest fears of any expecting mother is her weight gain and how she will lose all that pregnancy weight. With twins, weight gain is bound to be greater, and losing the weight may take longer. Focus on the babies' nutrition now, and leave the weight-loss worry for later.
Low birth weight in multiple pregnancy is common. Risks can be minimised with proper prenatal and postnatal care. Find a good doctor at a good hospital with state-of-the-art facilities, so you and your babies can get the best possible care. It is essential to choose a doctor and hospital well-experienced in multiple births to manage complications, if any.
Twins and triplets are more common in IVF than in natural conception. The risk of low birth weight is higher in multiple births than in single births. While the risk of low birth weight in twins is less than 60%, it increases to more than 90% in triplets.
In a multiple pregnancy, more babies are sharing the limited space in the placenta. As the babies grow and gain weight, the placenta stretches. The overstretching can trigger contractions, leading to premature birth.
Yes, fertility clinics can reduce the risk of premature births in multiples by opting for single embryo transfer, selective embryo reduction in the case of three or more babies, and by offering personalised treatment. They can closely monitor the pregnancy to ensure the babies are developing as expected, and intervene if and when necessary.
The chances of a full-term delivery in a multiple pregnancy are definitely lower than those of a single pregnancy. Almost 60% of twins and 90% of triplets are delivered preterm. In many cases, the doctor may choose to deliver the babies early if they are at risk. If the babies are developing well and the mother’s health is up to the mark, a full-term pregnancy is possible even in the case of multiple pregnancy.
