Being pregnant with twins is incredible at any age. For the mom over age 30, it may seem even more amazing, but it is not that uncommon. According to the Centers for Disease Control and Prevention, twin birth rates in the United States have been rising. From 1980 to 2009 the twin birth rate doubled among white mothers alone. The increase in twin births was greatest among mothers over the age of 35, and particularly in mothers age 40 and older, among whom twinning rates rose by more than 200 percent (more than doubled).
A few factors are thought to have contributed to this rise in multiple pregnancies. Women in their thirties are naturally more likely to conceive twins as a result of greater fluctuations in hormone levels—specifically follicle-stimulating hormone (FSH) levels, which stimulate egg production for ovulation. Another factor is the increase in the use of fertility treatments among older mothers. Assisted reproduction technologies such as in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI), as well as fertility medications, increase the chances of conceiving multiples. Another factor identified in a study published in Obstetrics & Gynecology may be a high maternal body mass index (BMI). The authors found that women with a pre-pregnancy BMI of 30 or more were significantly more likely to conceive fraternal twins than mothers with lower BMIs.( A BMI of 25 is the upper limit of normal, while a BMI of 30 or higher is the definition of overweight.)
If you are an older women expecting more than one, you can look forward to more frequent prenatal monitoring. It makes sense that the risk of complications increases with age and the number of fetuses. More twin babies than single babies are born prematurely. Carrying more than one can be challenging. The older body may not respond to pregnancy as well as the younger body, but with the right preparation and prenatal care, you can carry your twins confidently and safely.
Pregnancy Symptoms in Older Women Carrying Twins
The older a women is when she becomes pregnant, the greater the toll on the body. An older woman may experience symptoms more acutely because the body’s ability to react to stress decreases with age. Although the same pregnancy symptoms can occur in mothers regardless of age, some symptoms may be exacerbated in mothers of twins. These include:
- Aches and pains
- Fetal movements
- Gastrointestinal issues, such as heartburn, indigestion, and constipation
- Morning sickness
Every multiple pregnancy is different, and double the fetuses does not always mean double the discomfort. Typically, the extra weight you’ll carry and the extra hormones you’ll produce cause more symptoms. Older women carrying twins may have difficulty distinguishing a normal symptom of pregnancy from an abnormal one. For your health and the health of your babies, it is always best to err on the side of caution and discuss any concerns with your doctor.
Risks in Older Women Carrying Twins
Women who become pregnant later in life are already in the high-risk category. A high-risk pregnancy is one in which health concerns exist that may threaten the natural course of the development or birth of the baby, or that pose a risk to the mother. Women aged 35 years and older are more likely to have high blood pressure, diabetes, fibroids (benign growths) in the uterus, and problems during labor. The risk for a baby to be born with a chromosome abnormality increases with the age of the mother. Some experts believe that this is because the eggs are aging, and may have the incorrect number of chromosomes at the time of fertilization. There is a higher risk of miscarriage in older pregnant women and a higher risk of pregnancy-related complications that can lead to a cesarean section delivery. An older woman will face these risks regardless of how healthy she is at the time of conception, even when carrying just one baby.
A twin pregnancy has increased risks for complications but is not always considered “high risk.” Having more than two is considered high risk. Being older and carrying twins does not necessarily mean you will have a more difficulty pregnancy. If any problems do arise, how well you recover from them depends more on your health than your age. Even complicated twin pregnancies can result in two healthy, beautiful babies.
Complications in Older Women Carrying Twins
Although an older women carrying twins is at greater risk for complications than a younger woman carrying twins, she may not have any complications, especially if this is her first pregnancy. On the other hand, complications that occur in older mothers of multiples may be more severe. Twin pregnancies are accompanied by similar complications in women of any age. The most common complications include:
- Early delivery: More than half of twins and nearly all triplets are born early, or before 37 weeks, which is considered full term.
- Low birth weight: Because most mothers of multiples deliver early, they will often have small babies. Most babies of multiple pregnancies weigh less than five and half pounds at birth. However, these babies tend to do fine and develop normally. Premature babies born weighing less than four pounds are at greater risk for complications, as many of their organs may not be ready for life outside the mother’s uterus and may be too immature to function well.
- Pregnancy-induced hypertension: High blood pressure is more common among women carrying multiple fetuses because of the added placenta and hormones needed to sustain more than one baby. Persistent hypertension can lead to preeclampsia in some women.
- Gestational diabetes: This can happen when elevated hormone levels interfere with the mother’s ability to process insulin. The condition is more likely to occur in mothers of multiples because of the major dietary requirements of pregnancy. Adjustments in diet can usually control or prevent gestational diabetes.
- Twin-to-twin transfusion syndrome: This condition can affect identical twins who share a placenta. It occurs when blood vessels in the placenta cross, resulting in one fetus receiving too much blood flow and the other receiving too little. This can be dangerous for the babies, and treatment requires invasive procedures to correct the blood flow. It does not occur with fraternal twins.
- Placental problems: The large placental area and over-distended uterus place a mother carrying multiples at risk for placenta previa and placental abruption. While placenta previa is usually caught early and managed effectively without trouble, placental abruption cannot be detected before it happens. However, an abruption is usually a manageable event, and further complications can be avoided. If you have any red vaginal bleeding during pregnancy, contact your doctor right away.
Prenatal Care of Older Women Carrying Twins
If you are an older woman carrying twins, you will need more frequent prenatal visits to check for complications and to monitor nutrition and weight gain. You will also require more ultrasound testing to monitor the health of the fetuses, especially if there are complications. When expecting multiples, you can expect to have more of everything than a mother who is only expecting one baby. NIPT (non-invasive prenatal testing) is also strongly recommended for women over the age of 35 who are attempting to conceive.
Your doctor will provide you with guidelines for what and how much to eat and how much weight to gain. Mothers carrying two or more fetuses need more iron, protein, and other nutrients. According to the American College of Obstetricians and Gynecologists, women carrying twins should gain at least 35 to 45 pounds. The same guidelines apply to mothers of any age, but doctors will consider the mother’s age and health before making any recommendations. Just like younger mothers of twins, older mothers of twins need to make healthy choices. They need to eat healthy and stay physically active. For older women, it is especially important to learn about prenatal genetic testing and the risk of chromosomal abnormalities.
The need for bed rest is a common concern among mothers of multiples. The reason a mother requires bed rest may not have anything to do with her age, but more often depends on pregnancy complications or the number of fetuses she is carrying.
While being pregnant with twins at any age can be exciting, you may have mixed feelings. It is not wrong to feel this way. Most apprehensive expecting couples benefit from being part of a group for parents of multiples. Sharing your feelings with others in the same situation can reduce anxiety and help you prepare for what’s ahead. You will no doubt find out that twins, while double the effort, are also double the pleasure.