01 Sep 2011
By J.R. Wu
They are called multiple births – twins, triplets, quadruplets, and so on – and they are on the rise in a medically-advanced, prosperous country like Singapore. Couples who enjoy the active lifestyle the Lion City offers are planning for kids later in life. But starting a family later means the woman is likely older, and conception, probably harder. Often, many turn to fertility drugs or assisted reproductive technology, such as in vitro fertilisation (IVF), which often leads to multiple birth pregnancies.
But a multiple birth pregnancy – as opposed to a single birth pregnancy – carries with it serious risks.
“Chances are they would have a successful pregnancy and go home with healthy babies,” said Dr Tan Wei Ching, Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH).
“But they must also be aware of the risks and be prepared for the worst – the worst being premature, sick babies who require prolonged hospital stays.”
Dr Tan, who is trained in foetal medicine and has practised in Singapore for nearly 15 years, estimated that 70 per cent to 80 per cent of multiple birth pregnancies she sees end up with no problems for the mother or her newborns.
But the risk for complications goes up dramatically with the number of foetuses in one pregnancy. The risk for cerebral palsy, for example, is three times higher for triplets, but rises to 10 times for quadruplets, Dr Tan said. Older mothers are also at risk of having babies with Down’s Syndrome. In Singapore, women older than 35 years of age are considered to be at a higher risk than younger mothers of having a Down’s Syndrome baby.
Other risks in a multiple birth pregnancy include miscarriage; foetal growth restriction as foetuses fight for food and room in the womb; preterm labour; and prematurity of the newborn, which can lead to lifelong developmental problems for the child.
The woman pregnant with multiple foetuses will also be more prone to preeclampsia, or hypertension, due to the bigger placenta needed to support more than one foetus, as well as gestational diabetes.
Identical twins usually share one placenta - the flat organ that attaches to the inside of the uterus and is connected to the foetus by the umbilical cord. Non-identical foetuses often have their own. The placenta links the blood supply of the embryo to the blood supply of the mother, allowing the exchange of oxygen, nutrients, and waste products. The larger placenta and higher hormone levels can lead to more severe morning sickness, and if she isn’t able to hold down her food, the mother and her foetuses can become malnourished.
A good pregnancy regime includes a healthy diet and adequate exercise. However, potential parents must be aware of their options when risks arise. Having bed rest or taking vitamins or hormones can help reduce the risk of preeclampsia or preterm labour. When a multiple foetal pregnancy starts to become too much of a health risk for the mother and/or the foetuses, the family may be offered the option of reducing the number of foetuses in the womb. Known as Multifetal Pregnancy Reduction, the ultrasound-guided procedure can reduce the number of foetuses to lower the risks that a larger number of foetuses present to the mother and the pregnancy.
“It doesn’t eliminate the risk of your pregnancy as compared to any other single (foetal) pregnancy but you no longer have the risks associated with a multiple (foetal) pregnancy,” said Dr Tan. But, she added, that the procedure is not a “sure-fire method” either. It must be done before the 11th to 13th week of gestation, and carries the risk of losing some, or all of the remaining foetuses, bleeding and infection.
Before the procedure is allowed, the case has to be put forward to the hospital’s Bioethics Committee for consideration and approval. The family will also be counselled by a psychologist.
Once mother and babies go home, she faces a lot of physical fatigue, especially if she’s breastfeeding more than one newborn, which can be difficult and a round-the-clock affair. If the new mother has the support and encouragement she needs from her partner and their family, it will help her on her road to recovery.
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