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Pregnant With Triplets? What You Should Know

Written by WebMD Editorial Contributors

In this Article

  • What Causes Triplet Pregnancies?
  • Risks Associated With Triplet Pregnancies
  • What Triplet Pregnancies Are Like for the Mother

Many women look forward to becoming pregnant and starting or growing their family. Most of the time, you don’t expect to see three tiny fetuses on your ultrasound. But if you do, here’s what you need to know about triplet pregnancy. 

What Causes Triplet Pregnancies?

If you’re pregnant with more than one baby, it is often referred to as multiples. Pregnancies of more than one child represent approximately three in 100 births. If more than one egg is fertilized and implants in the uterus, your multiples are fraternal. If one egg is fertilized and splits before implanting in the uterine lining, you have identical multiples. In triplets — or any multiples more than two — the siblings can be all fraternal, all identical, or a combination of both.

There are several factors that increase your chances of being pregnant with more than one baby: 

  • Heredity. If you have a family history of multiple babies during pregnancy, it’s more likely that you will have twins or triplets.
  • Age. If you’re older than 30, there’s a greater chance you’ll have multiples.
  • Previous pregnancies. If you’ve been pregnant at least once before, you’re more likely to have a multiple pregnancy your second or third time. This is especially true if you previously gave birth to twins or triplets.
  • Race. African American women are more likely than any other race to have a multiple pregnancy. Asian and Native American women are the least likely. White women who are older than 35 have the highest rate of multiple births that are more than twins (triplets, quadruplets, etc.).
  • Ovulation-stimulation medicine. Medications like clomiphene citrate and follicle-stimulating hormone (FSH) help your body produce eggs. These are often used for low fertility but can lead to a triplet pregnancy if multiple eggs are released and fertilized. 
  • In vitro fertilization (IVF). This and other similar treatments help parents get pregnant by fertilizing eggs in a lab and then returning them to the uterus to grow. IVF pregnancies are more likely to produce multiples than natural pregnancies.

Risks Associated With Triplet Pregnancies

Premature birth. The greatest risk in carrying triplets is your babies being born prematurely. In fact, 60% of all multiple pregnancies occur before 37 weeks of gestation. The average gestation for a triplet pregnancy is even lower, at 32 weeks.

Delivery. Many triplet pregnancies end in a cesarean section for the safety of the babies and the mother. The probability of a vaginal delivery depends on:

  • Size of each baby
  • Positions of the babies
  • Health of the babies
  • Size and shape of the mother’s pelvis 

During pregnancy, it is important to be aware of the signs of premature labor:

  • Pelvic pressure
  • Lower back pain
  • Significant vaginal discharge
  • Change in frequency or intensity of contractions

If you suspect you are experiencing premature labor, contact your doctor immediately. If caught early enough, the labor can be stopped so your babies have longer to grow.

Placenta. The placenta is an organ that attaches to the wall of the uterus and transfers blood, oxygen, and nutrition from mother to baby through the umbilical cord. When a placenta supports more than one baby, it ages faster, limiting your babies’ growth potential.

The placenta may also provide imbalanced nutrients to each baby, causing one to grow larger while another remains smaller.

Preeclampsia.Preeclampsia is a dangerous condition when your blood pressure gets too high during pregnancy, putting you at risk for seizures. You’re at a much higher risk for preeclampsia with triplets. Symptoms of preeclampsia include:

  • High blood pressure
  • Protein in urine
  • Swelling in the legs, hands, face, and sometimes the entire body
  • Headaches
  • Changes in vision
  • Nausea and abdominal pain
  • Trouble breathing

Diabetes. Gestational diabetes is very common in women with triplet pregnancies. However, it is also common in pregnancies of only one baby, so it is well known and easy to manage. 

Newborn complications. The average weight at birth for triplets is just under 4 pounds. Approximately 20% of triplet pregnancies result in one child having a life-long handicap of some sort. Preterm delivery means an increased risk that your baby’s lungs, eyes, brain, circulatory system, and intestinal system are not fully developed yet.

It is likely that your babies will require a stay in the neonatal intensive care unit (NICU) where any complications will be treated, and they can thrive and grow. 

What Triplet Pregnancies Are Like for the Mother

Due to the greater risks associated with pregnancy with triplets, you will need more medical care during your pregnancy. Even if everything goes well, you should still be seeing your doctor more often to check for issues with your babies.

You are more likely to experience common pregnancy symptoms like reflux, hemorrhoids, constipation, back pain, and varicose veins. You will also grow bigger more quickly, which may mean you need supplements or a specific nutrition plan. Talk to your doctor to create a plan for your triplet pregnancy.

Multiple pregnancy (triplets or more)

Multiple pregnancy (triplets or more) | Pregnancy Birth and Baby beginning of content

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During your pregnancy, you may find out that you're expecting 3 or more babies. This can sometimes be a surprise or even a shock. Most families with multiple pregnancies find having several babies at once to be a very positive experience. Being pregnant with triplets or more does mean you will need extra medical support throughout your pregnancy.

How do 'higher order multiples' occur?

If you are having 3 or more babies, they are known as 'higher order multiples'. This sort of multiple pregnancy can occur when:

  • a single fertilised egg splits
  • more than one egg is fertilised

Both of these things can also happen at the same time. This means that multiple babies could be fraternal (non-identical) or identical.

Higher order multiples rarely happen naturally and are usually the result of fertility treatments.

In 2020, 1.4% of all births in Australia were multiple births. Of these, almost all were twins. Just 1 in 100 of the multiple births were triplets or higher.

You can find out if you are having a multiple birth when you have an ultrasound.

When carrying triplets or more, you can expect the same early pregnancy symptoms that you would have with one baby. But they can start sooner and be more severe.

You will need extra medical care throughout your pregnancy. Choose an experienced doctor and medical support team that is right for you.

You may see a team of health care professionals who are experienced in higher order multiple pregnancies. These may include:

  • obstetricians (specialist doctors who give medical care during pregnancy and birth)
  • midwives (specialist nurses who give medical care during pregnancy and birth)
  • sonographers (specialist in imaging with ultrasound)
  • physiotherapists
  • dietitians

You will need tests such as a glucose tolerance test to check for gestational diabetes. Frequent ultrasounds may be recommended to see how your babies are growing. Ultrasound scans can also check whether there are any problems with the placentas or cords.

The most common pregnancy complication with triplets or more is premature birth. Your healthcare team will keep a close eye on your health. Carrying multiple babies puts you at higher risk of certain problems. These can include:

  • pre-term labour (going into labour early)
  • anaemia (not having enough red blood cells, usually caused by iron deficiency)
  • gestational diabetes (diabetes during pregnancy)
  • hypertension or pre-eclampsia (potentially dangerous forms of high blood pressure)
  • hyperemesis gravidarum (severe morning sickness)
  • polyhydramnios (having too much amniotic fluid around the baby)
  • miscarriage or stillbirth (sometimes one of the babies may die in the womb)
  • Postpartum depression (also known as postnatal depression, and perinatal anxiety and depression)
  • postpartum haemorrhagep (heavy bleeding after the birth)

Talk to your healthcare team if you have any concerns while you are pregnant.

Looking after yourself during multiple pregnancy

Having a multiple pregnancy can be physically and mentally overwhelming. It is important to take care of yourself. Make sure to surround yourself with a positive support network.

Nutrition

If you are carrying triplets or more, you may grow bigger than with a normal pregnancy. You may also grow more quickly. You will need to eat more to meet the babies' nutritional needs, and your own.

You may need to take iron, calcium, Vitamin B12 and folic acid supplements. Your healthcare team will provide you with a nutrition plan.

Conditions associated with pregnancy

With a multiple pregnancy, you may be more likely to experience:

  • reflux
  • haemorrhoids
  • varicose veins
  • constipation

See your doctor for information and advice about how to manage these symptoms.

You may experience backache, so correct posture is very important. To keep good posture while pregnant, you should:

  • continue gentle exercise as advised
  • bend your knees when lifting
  • tilt your pelvis forward when sitting, standing, or lying down
  • consider stomach support

Activity and rest

Doing some gentle exercise during pregnancy can help ease tension and improve your muscle tone.

Towards the end of your pregnancy, you may need to make some changes, such as

  • limiting physical activity
  • limiting travel
  • possible bed rest

You can feel very tired in the later stages of the pregnancy. You may have problems sleeping. Frequent rest and drinking plenty of water will help.

You will also usually have to stop work earlier than with a single pregnancy. Your healthcare team can advise you on the right time for this.

Preparing for multiple babies

Be as prepared as you can. The babies are likely to be born earlier so it's a good idea to get the nursery ready.

Attend antenatal classes earlier than you would for a single pregnancy. Some classes or information evenings are designed specifically for women expecting multiple babies. These sessions can provide support, and a chance to meet other families.

Before your babies are born, you can speak with your midwife or lactation consultant about feeding. They can provide advice and support on:

  • what to expect when feeding multiple babies
  • positions for breastfeeding
  • different baby formula options
  • how to bottle feed
  • what equipment you may need

When are multiple babies born?

While a normal pregnancy usually lasts 40 weeks, triplets are often born earlier.

Usually, the longer your babies can stay in the uterus, the better. But when you are pregnant with triplets or more, complications can often develop. With some complications, it may be better for you and your babies if they are delivered early.

Most multiple births take place by caesarean section. Your medical team will decide when to deliver. This will be based on your health and the health of the babies. You may need to stay in hospital for a while before the birth.

If you experience any signs of preterm labour, call your doctor immediately.

Where to find more information

If you are expecting higher order multiples, it's common to worry about things such as:

  • possible pregnancy complications
  • changes to your body
  • how your other children will cope
  • what help you will need

For support and resources, contact the Australian Multiple Birth Association.

You can also call Pregnancy, Birth and Baby on 1800 882 436 for advice or support 7 days a week

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Sources:
Australian Multiple Birth Association (What to expect when you're expecting multiples), Australian Bureau of Statistics (Births, Australia), Multiples NZ (Pregnancy and Birth)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: June 2022


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