If you have very strong symptoms early in your pregnancy, you may be carrying multiples. When you have your first ultrasound, usually some time in the first trimester, you will know for sure. With so many people taking fertility drugs these days, the incidence of multiple pregnancies has increased. If you are carrying multiples, you might be worried about the outcome of your pregnancy, but with modern medicine and technology, most multiple births now have healthy outcomes.

While most outcomes are positive, there is a higher risk to you and the fetuses. Multiple fetuses do have an elevated risk of genetic problems and birth defects. The more fetuses you are carrying, the greater the risk. Multiples tend to be born prematurely, which increases the risk after birth.

When you are carrying multiples, it is natural to gain more weight than you would if you were only carrying one fetus. How much weight you should gain depends on how many fetuses you are carrying, and whether you started the pregnancy overweight or underweight. Your doctor should tell you what a good range of weight gain for your pregnancy is.

Your doctor will monitor your pregnancy more closely than with a single fetus pregnancy, and you will have more frequent appointments. You may have more testing done than you would otherwise to monitor the health of the fetuses and you. Problems that are most likely to occur with multiple pregnancies include: pre-eclampsia, placental problems, anemia, too much amniotic fluid, urinary tract infection and postpartume hemorrhage. Risks to the fetus include the healthy growth of one or more at the expense of the others, birth defects and disabilities.

Many of the risks associated with multiple births are due to the fact that the births are more likely to be premature. You should try to arrange with your doctor to have the birth done at a specially equipped facility that has a neonatal intensive care unit, and where emergency caesareans deliveries can be done.

If you have triplets or more, the risks of problems and even death increase with each additional fetus. Your doctor may offer you multifetal pregnancy reduction around the end of the first trimester. This is a very difficult decision, as it means terminating one or more of the fetuses to improve the odds of a healthy outcome for the remaining fetuses as well as reducing the risk to you. However, there is a heightened risk of miscarriage if the procedure is performed. As difficult as this decision may be, you may need to weigh the risks. It may also help to talk with a spiritual advisor, or mental health professional.

There are several things you can do to improve the odds of a positive outcome for your multiple pregnancy. Because you are feeding multiple fetuses, it is even more important that you get ample nutrition, and get extra amounts of folic acid, iron and calcium. You should reduce your physical activity and avoid any strenuous exercise after week 24. You may need to change your work arrangement, especially if you are on your feet or moving around a lot. You should see your doctor very often.

If you take all of these precautions, and your pregnancy is carefully monitored, then you have the greatest chance of achieving a positive outcome. Then comes the hard part of caring for all those little bundles of joy!