The 10 Worst Things About Twin Pregnancy

You're having twins! It's an exciting time of joy and anticipation as you look forward to the arrival of two babies. How pregnancy that yields two babies! Right? While there are wonderful benefits to a two-for-one pregnancy, there can also be some drawbacks. Some of the regular side effects of pregnancy are magnified with twins, and sometimes a twin pregnancy brings its own unpleasant complications.

However, it's vital to note that no two pregnancies (even those of twins) are the same. Some women will experience many challenging side effects of carrying twins, while others will have very few or none. The bottom line is that every pregnancy experience is unique—but the more you know about the possible difficulties of a twin pregnancy, the better prepared you can be to cope with whatever comes your way. Here are the 10 biggest challenges you might face.


Morning Sickness

One of the first (and arguably, worst) symptoms of pregnancy is morning sickness. For many moms, morning sickness doesn't just hit in the morning—it can last all day. Usually experienced in early pregnancy, it is often intensified for moms of multiples.

It's estimated that around 70% of pregnant women have morning sickness—and studies show that twin pregnancies may experience it more frequently and with stronger symptoms. 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.



Heartburn is one of the most uncomfortable physical effects of pregnancy, with between 17% and 45% of pregnant women experiencing it. This side effect can keep you awake at night and turn eating into a chore, making it difficult for you to consume enough calories and fluids. The burning sensation in your lower throat or upper chest is triggered by your expanding uterus and increasing hormones.

Heartburn can be experienced at any point in pregnancy. Studies are mixed on when it is most common but many show the incidence increasing 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.


Aches and Pains

Stretched ligaments, pelvic discomfort, lightening crotch, contractions, leg cramps, sciatica, back pain, pubic bone pain, and headaches are among the many common pregnancy symptoms that can produce pain all over your body. While there are few studies specifically on how twin pregnancies experience these side effects compared with singleton pregnancies, anecdotal evidence indicates that they're often more severe.

It makes sense, after all, that when there is more than one baby, aches and pains are likely to be intensified due to the larger and faster-growing uterus and the added work the mother's body must do to grow two rather than just one baby. However, as noted above, every pregnancy is different and each person will experience their symptoms uniquely.

The key is not to just accept any discomfort as a matter of course. Instead, be sure to talk to your doctor about any symptoms you are experiencing as there are often helpful remedies available—and some side effects may be cause for concern that require an evaluation and/or treatment.

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

Tingling and numbness in the arms and hands may be a surprising side effect of pregnancy. 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 this side effect, which occurs 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 that produces painful sensations. Swelling and weight gain tend to be more pronounced in twin pregnancies, as well as the accompanying shifts in posture that also can pinch nerves, all of which may explain the increased risk of carpal tunnel syndrome.


Lack of Sleep

Most parents expect to experience sleepless nights when their twins are babies. However, you may be surprised by how difficult it can be to get proper rest during pregnancy with multiples. Sleeping well is often challenging in any pregnancy, particularly in the third trimester as the growing baby impedes finding a comfortable position and other common pregnancy symptoms often feel more apparent when settling down at night.

However, again, due to the fact that twin pregnancies often mean increased weight gain, swelling, hormonal shifts, and a larger uterus, sleep issues can be exacerbated when carrying multiples. Physical discomfort and anxiety relating to the pregnancy commonly result in occasional restlessness or insomnia. In fact, studies show that around 13% of pregnant women experience insomnia in the first trimester alone.


Weight Gain

People are often concerned about weight gain during pregnancy. 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 extra weight is important for the health of your babies and can be attributed to the babies' combined weights, but also to 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.


Stretch Marks

While many of the symptoms of pregnancy disappear once the babies are delivered, stretch marks can last a lifetime—however, they do tend to fade with time. There's no doubt that moms of twins will be stretched to the limit as their body accommodates two babies. Their stretching skin can result in a separation of collagen that leaves pink or purplish marks on the abdomen, breasts, hips, or thighs.


Sheer Girth

How big will you get? For some moms, it is not the pain, discomfort, or worry that is the worst thing about twin pregnancy. Rather, it is the sheer girth of a body incubating two babies. It's not just 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, or get up out of bed.


Bed Rest

While it may sound like a vacation to spend days or weeks in bed, medical bed rest can take a serious mental and physical toll. 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. 

It's important to note that while bed rest is often prescribed for twin pregnancies, research on the efficacy of routine bed rest for multiple births does not show clear benefits to the practice—and indicates potential for adverse effects.

For this reason, strict bed rest is prescribed less often than in the past. More often, today, doctors 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 indication of need and to determine exactly what you can and can not 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 complication. 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. In addition to the limiting factor of your uterus expanding to fit your babies, multiple gestation pregnancies carry higher risks for other complications that all increase the chance of preterm labor, including 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 when it comes to pregnancy complications and outcomes. Most importantly, there are also plenty of treatments and coping mechanisms available to help alleviate most symptoms.

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