The 10 Worst Things About Twin Pregnancy

There are wonderful benefits of a twin pregnancy. But to be fair to all of the soon-to-be moms out there, the picture isn't complete unless attention is given to some of the drawbacks, too.

Namely, some of the regular side effects of pregnancy are magnified with twins, and sometimes a two-for-one pregnancy brings its own potential complications.

Read on to learn about 10 of the biggest challenges you might face if you're pregnant with twins. But remember: No two pregnancies are the same—even if both involve twins. Your experience is uniquely yours.


Morning Sickness

Pregnant woman standing over sink with hand on mouth from morning sickness

Vesna Andjic / Getty Images

One of the first (and arguably, worst) symptoms of pregnancy is morning sickness. Usually experienced in early pregnancy, it is often intensified for moms of multiples.

For many moms, morning sickness doesn't just hit in the morning—it can last all day. And studies show that twin pregnancies may prompt more frequent and stronger symptoms.

It's estimated that around 70% of pregnant women have morning sickness. Just over 1% have a more severe form of morning sickness called hyperemesis gravidarum (HG).

On the plus side, this side effect usually begins to decline and/or disappear at the start of the second trimester. Additionally, studies have found that having morning sickness may reduce your risk of miscarriage.



Between 17% and 45% of pregnant women experience heartburn, and it can be experienced at any point in pregnancy.

Studies are mixed on when it is most common, but many show the incidence increases as pregnancy progresses.

In early pregnancy, hormones may be more to blame, while in later pregnancy, the growing uterus is thought to be a primary culprit. This is why twin pregnancies, which tend to be larger, may be at added risk of this complication.

Heartburn is one of the most uncomfortable physical effects of pregnancy. The burning sensation in your lower throat/upper chest can keep you awake at night and turn eating into a chore, making it difficult for you to consume enough calories and fluids.


Aches and Pains

Stretched ligaments, pelvic discomfort, lightning crotch, contractions, leg cramps, sciatica, back pain, pubic bone pain, and headaches are among the many aches and pains that pregnant women may experience.

While there are few studies specifically on how twin pregnancies and singleton pregnancies compare when it comes to these issues, it makes sense that women pregnant with multiples may experience them with greater frequency and severity. When there is more than one baby, the uterus is larger and faster-growing, which can put added pressure on nerves, muscles, and more.

Though some aches and pains are to be expected, don't accept any discomfort as a matter of course. Instead, be sure to talk to your doctor about any symptoms you are experiencing.

They can evaluate you to make sure there isn't a larger concern and recommend treatment to ease your symptoms.

Contact your doctor right away if you experience any symptoms that concern you, particularly when accompanied by moderate to severe pain, vaginal bleeding, headache, diarrhea, fever, cramping, contractions, swelling, dizziness, and/or persistent vomiting.


Carpal Tunnel Syndrome

While many people know that carpal tunnel syndrome is caused by too much typing, it can also be brought on by pregnancy. In fact, studies show that around a third or more of pregnant women experience it, most often in the third trimester.

The "tunnel" formed by the bones and ligament in the wrist can become compressed by the swelling and fluid retention common in pregnancy. This squeezes a nerve and produces tingling and numbness in the arms and hands.

Swelling and weight gain tend to be more pronounced in twin pregnancies. So too are the accompanying shifts in posture that also can pinch nerves. All of this may explain the increased risk of carpal tunnel syndrome in women carrying multiples.


Lack of Sleep

Sleeping well is often challenging in any pregnancy, particularly in the third trimester as the growing baby makes finding a comfortable position difficult.

Common pregnancy symptoms are often more apparent when settling down at night, which complicates things further.

The increased weight gain, swelling, hormonal shifts, uterus size associated with twin pregnancies mean these issues can be compounded, making sleep even harder to get.


Weight Gain

As you might suspect, a person who is having multiples will see more of an increase on their scale than if they were only having one baby.

The weight can be attributed to the babies' combined weights, as well as extra fluid, tissue, and uterine growth. There is also an increased blood volume to supply the placenta(s) with nourishment for two or more babies.

Carrying extra weight can make it more difficult to move around freely and zap your energy. However, gaining weight is important for the health of your babies. In fact, gaining the recommended amount for your body is linked to better outcomes for your babies.


Stretch Marks

As a baby grows, the uterus expands—and a mother's skin stretches to accommodate it.

This stretching can result in a separation of collagen that leaves pink or purplish marks on the abdomen, breasts, hips, or thighs—better known as stretch marks or striae gravidarum (SG). It is estimated that between 55% and 90% of pregnant people get SG, so the condition is by no means limited to multiple pregnancies.

Research is unclear on the exact causes for SG but studies show that gaining more weight during pregnancy (as is typical in multiple pregnancies) is associated with an increased risk of stretch marks.

It stands to reason that the more the skin has to stretch, the greater your stretch marks may be in number and severity.

Needless to say, two babies need more room than one, which may make SG more likely for women carrying twins. Other suspected causes and risk factors include family history, hormonal shifts, higher body weight, and younger maternal age.

Stretch marks can last, though they tend to fade with time.


Sheer Girth

Carrying extra weight is one thing, but the sheer girth of a body incubating two babies can be its own challenge.

Aside from a big belly, every part of a body carrying twins can be affected by swelling and bulges.

Growing larger and larger, it becomes difficult to navigate through doorways, get in and out of the car, find clothing that fits comfortably, or get up out of bed.


Bed Rest

Bed rest, either at home or in a hospital, may be prescribed for pregnant mothers of multiples for a variety of reasons.

Most commonly, bed rest is advised in order to prevent preterm labor, which occurs far more often when carrying more than one baby.

While some time in bed may sound enticing, medical bed rest is restrictive and can be lengthy, which can take a mental and physical toll.

While bed rest is often prescribed for twin pregnancies, research on the efficacy of routine bed rest for multiple births does not show conclusive benefits to the practice. In fact, there is potential for adverse effects, such as the development of venous thromboembolism or psychosocial effects from extended inactivity.

For this reason, strict bed rest is prescribed less often than in the past. More often, doctors today may simply advise "taking it easy" or limiting activity.

If bed rest is recommended for you, talk to your doctor to make sure there is a clear need and to clarify exactly what you can and cannot do.


Preterm Labor

While not every mom of multiples contends with preterm labor, many mothers of twins and nearly all mothers of triplets or more will face this.

In fact, it's estimated that while around 10% of singleton births are preterm, over 50% of twin births come before 37 weeks gestation.

Preterm labor carries serious risks for both the baby and pregnant mother, which is why twin births are monitored more closely than singletons.

In addition to the limiting factor of your uterus only expanding so far to fit your babies, multiple gestation pregnancies carry higher risks for other complications that all increase the chance of preterm labor. These include preeclampsia, intrauterine growth restriction, blood clots, and pregnancy-induced hypertension.

A Word From Verywell

Remember that while it's true that multiple gestation pregnancies can bring about more side effects (and risks) than a singleton pregnancy, this is not always the case.

Your general health, fitness, lifestyle, and prenatal care also make a big difference. Thankfully, there are also plenty of treatments and strategies to help alleviate most symptoms.

13 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Pamela Prindle Fierro
 Pamela Prindle Fierro is the author of several parenting books and the mother of twin girls.