Strategies to reduce the risk of premature birth

Given the high rates of prematurity for multiple births, is there anything that can be done to prevent it? Yes and no.

There are a range of medical conditions/complications, over which we have little or no control, that can result in an iatrogenic (planned) premature birth, including problems with your cervix or uterus, previous termination of pregnancy or preterm birth, intrauterine growth restriction, diabetes, pre-eclampsia and poor overall health.

There are also risk factors that we do have some, or complete, control over, that can contribute to prematurity, such as poor nutrition, smoking, stress, alcohol and drugs. Since a multiple gestation pregnancy is, itself, a known risk factor for premature birth, if you are pregnant with twins, you want to especially avoid these known risks.

Here are some proven strategies for prolonging pregnancy.

Stop smoking!

If you smoke, you NEED to stop—or, at the very least, reduce how much you are smoking. If you use alcohol or recreational drugs, a multiple pregnancy would be a good time to seek help to stop using them.

Antenatal care

Register for antenatal care early and let your LMC know about any previous gynaecological surgery, or previous health issues that may affect your care. At each visit, talk about how you are feeling and ask for information that will help you to stay healthy. If you have registered early, ask for ultrasound (before 16 weeks) to determine chorionicity, so that any risks can be fully assessed and referral organised.

Good nutrition and appropriate weight gain

Nutrition is very important if you are carrying twins: you need extra energy (calories), protein, iron, folate, calcium, vitamin D and essential fatty acids (e.g. fish oil capsules). Drink plenty of fluids (such as water anddiluted fruit juice) as thesewill help reduce the risk of urinary tract infections, which are thought to contribute to preterm birth.

Manage stress

Minimise stress levels by reducing extreme physical exertion, and ensuring that you get lots of rest. If possible, take early   maternity leave, and avoid major stressors, such as moving house or long-distance travel. If you are finding it tough, emotionally, talk to someone. Aim to keep 50% of your energy in reserve.

Monitor for preterm labour

Know the early warning signals of pre-term labour—and get medical help, fast! For many women, this will mean following your instincts that something is wrong. If premature labour is detected early enough, it is often possible to delay it; if not, you can be given steroids to help the babies lungs develop.

Be assertive

You will need to become an expert on your multiple pregnancy, and make sure that you get the care that you need. Dr Kennneth Moise, part of the ground-breaking Program for Multiples at the Texas Children's Fetal Center, suggests:

… if you're a mom expecting twins, my best advice is to be your own advocate. Start by asking the right questions. Find out if you are expecting fraternal or identical twins. Confirm that each baby has its own placenta and amniotic sac at your first ultrasound. Make sure the amniotic fluid levels stay balanced. Seek nutritional counselling from a registered dietician who understands the new guidelines for multiples. …[G]et frequent blood pressure checks, and request to be tested for anaemia and gestational diabetes at least twice during your pregnancy. Be assertive about scheduling additional ultrasounds - these should take place around 5 months to look for birth defects then every 4 weeks thereafter to watch your babies' growth.