Giving birth to twins (and sometimes to triplets) is a dream of many women, regardless of the fact, plural pregnancies are more difficult and requires a special vigilance. But all troubles are overcome due to some certain aureole of heroism and a wish to take all the pain at one go. It’s interesting, that for the last 20 years, statistics of giving birth to twins, triplets and more increased significantly. Deliveries of 0.5 – 2% of women finish with birth of twins, triplets, more seldom four and five babies.

Do you have a chance? This depends on several factors:

1. Age of a mother.
   This is one of the reasons of increasing amount of twins’ birth – a worldwide tendency to late deliveries. The probability of birth of two and more babies increases if a mother is older than 35 years. (By the way, this chance increases even more after 50 years). Unfortunately, You are half as likely to deliver multiples at 25 as you are at 35+.
2. Inheritance.
   If some of your or your husband’s relatives has twins, then your probability of giving birth to several babies at once is extremely high (especially, if you inherited this trait from your mother). And regardless of common opinion, this does not necessarily take place in one generation – you can inherit a gene which is responsible for formation of several ovules, suitable for insemination, in your organism.
3. Genesial technologies.
   Often women who were prescribed hormonal medicines during sterility treatment or while preparation to artificial extracorporal fertilization have plural pregnancies. Hormonal medicines stimulate ovulation in the midst of a cycle and if a woman receives overdose of a medicine then several ovules come out of ovary follicle at once, not just one. As a rule, doctors “remove” excess ovules. But sometimes women refuse due to religious or other motives. In USA and Israel there were cases when women gave birth to 6 or 7 babies at once.

Signs of plural pregnancy
It can be very easy to determine the quantity of babies you will birth – you can do it with the help of echography on 5-6th week of pregnancy, but there’re such situations when you cannot pass through echography. So, it will be good for you to learn some signs of pregnancy with twins. Moreover, doctors cannot always can give you an exact answer about your pregnancy during the first 10-12 days.

Psychological factor. You should not ignore your intuition. Many women can be sure that they are pregnant with twins since the moment of conceptiony. Often mothers of twins admit that they knew about their forth-coming birth on the earliest terms of pregnancy. If you feel you’re expecting twins tell your doctor about it for sure.

High biochemical indexes. Women pregnant with twins have increased indexes of some biochemical tests. For example, content of alpha fetoprotein or a high content of a hormone HCG (human chorionic gonadotropin), which supports pregnancy. While placenta is developing its presence can be determined in blood or urine even before the delay in menstruation, and lots of pregnancy tests are based on its indexes.

Intensive morning sickness and/or vomiting. More heightened in comparison with usual pregnancy, content of hormone HCG (pregnancy hormone) can increase morning sickness. Sickness, sometimes accompanied by vomiting, can already appear a week after conception, i.e. even before your usual menstrual cycle begins. Sickness appear more often in the morning but it’s also possible in any other time of a day.

Intensification of other pregnancy signs. Many (but not all) women expecting twins suffer from other intensified sings of pregnancy – due to a significant increase of hormones in comparison with usual pregnancy. For example, they feel heightened breast sensibility, more frequent impulses of urination, extreme tiredness and hunger. In the second term a woman may suffer from strong breathlessness, hands and legs spasms, sudden increase in weight and belly sizes, and an intensive stir of fetus. Hemoglobin decrease or anemia – are also usual events for plural pregnancy. And in general this is not surprising. During such pregnancies a load on a future mother’s organism increases several times, depending on the quantity of babies she’s bearing. Unfortunately, this means that complications are more often met during pregnancy.

Quick weight increase since the first days of pregnancy. By the way, this is one of the first sings of two babies’ present in a woman’s uterus. Double nutrition can play an important role during the first term of pregnancy. And a quick weight increase is necessary.

High physiological indexes. Doctors can usually tell during the first examination that your uterus size is little big for your assumed term of pregnancy. This tendency will remain for the whole term of pregnancy. Other physiological indexes will be bigger too: circularity of belly through navel, height of uterine fundus standing and others.

Heartbeat of two hearts can be heard. When a doctor begins listening to a baby’s heartbeat he will hear the beating of two hearts, instead of one. Two separate heartbeats can be heard on the 13th week of pregnancy.  By the 28th week a doctor will be able to determine 3-4 large parts of body (head and bum) and many small ones by touch.

About the Author
Yana Mikheeva is the creator of the Baby-Health.Net at http://www.baby-health.net Are you going to get pregnant? Visit our friendly resource and read information on pregnancy and parenting, painless childbirth, growth and development of a baby, baby health, safety, signs of pregnancy. She also has a blog for women at http://www.womanspassions.com/blog/.

 by Paula Kurtzweil

If you plan to have children some day, here’s important information for the future mother-to-be: Think folate now.

Folate is a B vitamin found in a variety of foods and added to many vitamin and mineral supplements as folic acid, a synthetic form of folate. Folate is needed both before and in the first weeks of pregnancy and can help reduce the risk of certain serious and common birth defects called neural tube defects, which affect the brain and spinal cord.

The tricky part is that neural tube defects can occur in an embryo before a woman realizes she’s pregnant. That’s why it’s important for all women of childbearing age (15 to 45) to include folate in their diets: If they get pregnant, it reduces the chance of the baby having a birth defect of the brain or spinal cord.

“Adequate folate should be eaten daily and throughout the childbearing years,” said Elizabeth Yetley, Ph.D., a registered dietitian and director of FDA’s Office of Special Nutritionals.

Folate’s potential to reduce the risk of neural tube defects is so important that the Food and Drug Administration requires food manufacturers to fortify enriched grain products with folic acid. This will give women one way to get sufficient folate: by eating fortified breads and other grain products, such as enriched pasta, rice, waffles and cereal bars.

Other ways to do this are:

• Eat fruits, dark-green leafy vegetables, dried beans and peas, and other foods that are natural sources of folate.
• Eat folic acid-fortified enriched cereal grain products and breakfast cereals.
• Take a vitamin supplement containing folic acid.

Nutrition information on food and dietary supplement labels can help women determine whether they are getting enough folate, which is 400 micrograms (0.4 milligrams) a day before pregnancy and 800 micrograms a day during pregnancy.

Neural Tube Birth Defects
The technical names of the two major neural tube birth defects reduced by adequate folate intake are anencephaly and spina bifida. Babies with anencephaly do not develop a brain and are stillborn or die shortly after birth. Those with spina bifida have a defect of the spinal column that can result in varying degrees of handicap, from mild and hardly noticeable cases of scoliosis (a sideways bending of the spine) to paralysis and bladder or bowel incontinence. With proper medical treatment, most babies born with spina bifida can survive to adulthood. But they may require leg braces, crutches, and other devices to help them walk, and they may have learning disabilities. About 30 percent have slight to severe mental retardation.

The national Centers for Disease Control and Prevention estimate that about 2,500 infants with spina bifida and anencephaly are born each year in the United States.

Other maternal factors also may contribute to the development of neural tube defects. These include:

• family history of neural tube defects
• prior neural tube defect-affected pregnancy
• use of certain antiseizure medications
• severe overweight
• hot tub use in early pregnancy
• fever during early pregnancy
• diabetes.

Any woman concerned about these factors should consult her doctor.

Folate Link
Scientists first suggested a link between neural tube birth defects and diet in the 1950s. The incidence of these conditions has always been higher in low socioeconomic groups in which women may have poorer diets. Also, babies conceived in the winter and early spring are more likely to be born with spina bifida, perhaps because the mother’s diet lacks fresh fruits and vegetables–which are good sources of folate–during the early weeks of pregnancy.

In 1991, British researchers found that 72 percent of women who had one pregnancy with a neural tube birth defect had a lower risk of having another child with this birth defect when they took prescription doses of folic acid before and during early pregnancy.

Another study looked at folic acid intake in Hungarian women. The evidence indicated that mothers who had never given birth to babies with neural tube defects and who took a multivitamin and mineral supplement with folic acid had less risk in subsequent pregnancies for having babies with neural tube defects than women given a placebo.

These studies led the U.S. Public Health Service in September 1992 to recommend that all women of childbearing age capable of becoming pregnant consume 0.4 mg of folate daily to reduce their risk of having a pregnancy affected with spina bifida or other neural tube defects.

That corresponds to FDA’s Daily Value for folic acid, which is 400 micrograms for nonpregnant women, as well as children 4 and older and adult men. For pregnant women, the Daily Value jumps to 800 micrograms. Daily Values are dietary reference numbers used on the Nutrition Facts panel on food labels to show the amounts of various nutrients in a serving of food.

Many women between 19 and 50 consume much less than 400 micrograms of folate a day, according to the U.S. Department of Agriculture.

Folate Sources
Folate occurs naturally in a variety of foods, including liver; dark-green leafy vegetables such as collards, turnip greens, and Romaine lettuce; broccoli and asparagus; citrus fruits and juices; whole-grain products; wheat germ; and dried beans and peas, such as pinto, navy and lima beans, and chickpeas and black-eyed peas.

Under FDA’s folic acid fortification program, which became effective January 1998, the agency requires manufacturers to add from 0.43 mg to 1.4 mg of folic acid per pound of product to enriched flour, bread, rolls and buns, farina, corn grits, cornmeal, rice, and noodle products. A serving of each product will provide about 10 percent of the Daily Value for folic acid. Whole-grain products do not have to be enriched because they contain natural folate. Some of the natural folate in non-whole-grain products is lost in the process of refining whole grains.

Folate also can be obtained from dietary supplements, such as folic acid tablets and multivitamins with folic acid, and from fortified breakfast cereals.

A report recently released by the Institute of Medicine indicates that the evidence suggests that folic acid, the synthetic form of folate, may be better absorbed than folate found naturally in foods. The report also points out that, if taken in adequate amounts, food folate may eventually be demonstrated to be as effective as folic acid.

Some Good Sources of Folate
(The table below is also available as text for browsers that don’t support tables and as a 7K PDF file).

* based on Daily Value for folate of 400 micrograms
(Source: Food Values of Portions Commonly Used, 16th edition)

Finding Foods with Folate
Certain information on food and dietary supplement labels can help women spot foods containing substantial amounts of folate. Some labels may claim that the product is “high in folate or folic acid,” which means a serving of the food provides 20 percent or more of the Daily Value for folic acid. Or the label may say the food is a “good source” of folate, which means a serving of the food provides 10 to 19 percent of the Daily Value for folic acid. The exact amount will be given in the label’s Nutrition Facts panel.

Some food and dietary supplement labels may carry a longer claim that says adequate folate intake may reduce the risk of neural tube birth defects. Products carrying this claim must:

• provide 10 percent or more of the Daily Value for folic acid per serving
• not contain more than 100 percent of the Daily Value for vitamins A and D per serving because high intakes of these vitamins are associated with other birth defects
• carry a caution on the label about excess folic acid intake, if a serving of food provides more than 100 percent of the Daily Value for folic acid. FDA has set 1 mg (or 1,000 micrograms) of folate daily as the maximum safe level. There are limited data on the safety of consuming more than 1 mg daily, and there may be a risk for people with low amounts of vitamin B12 in their bodies–for example, older people with malabsorption problems, and people on certain anticancer drugs or drugs for epilepsy whose effectiveness can diminish when taken with high intakes of folate.
• list on the label’s Nutrition or Supplement Facts panel the amount by weight in micrograms and the %Daily Value of folate per serving of the product. This information, which appears toward the bottom of the panel, along with the listing of other vitamins and minerals, can be used to compare folate levels in various foods and supplements.

Optional information may appear with the health claim to let consumers know about other risks associated with neural tube birth defects, when to consult a doctor, other foods that are good sources of folate, and other important messages about neural tube defects.

Other Considerations
The claim about folate cannot imply that adequate folate intake alone will ensure a healthy baby, since so many factors can affect a pregnancy.

Women should bear this in mind when contemplating pregnancy, advises Jeanne Latham, a registered dietitian and consumer safety officer in FDA’s Office of Special Nutritionals. “Folate can make a significant contribution,” she said, “many factors, including an overall good diet, are involved in having a healthy baby.”

Genetics plays a role, as do other healthful prenatal practices, such as eating an all-around good diet. But unlike genetics, diet is a risk factor women can modify to their–and their baby’s–advantage, said Jeanne Rader, Ph.D., director of the division of science and applied technology in FDA’s Office of Food Labeling.

“Folic acid is one of many nutrients needed in a healthy diet for women of childbearing age,” she said. “A well-balanced diet with a variety of foods can provide all those nutrients, including adequate amounts of folate.”

Women have options for reaching the folate intake goal: They can get the necessary nutrients and calories both before and during pregnancy by eating a well-balanced diet, keeping in mind folate-rich foods, nutrition experts say. Folic acid-fortified grain products, including breakfast cereals, will help, too. Dietary supplements are another source of folate. Any one or a combination of these options for ensuring adequate folate can help assure women of childbearing age that, if they become pregnant, their babies will be off to a healthy start.

Paula Kurtzweil is a member of FDA’s public affairs staff.

Maternal and Child Health Clearinghouse
5600 Fishers Lane, Room 18A-55
Rockville, MD 20857
(703) 821-8955

March of Dimes Birth Defects Foundation
1275 Mamaroneck Ave.
White Plains, NY 10605
(914) 428-7100
Voice mail only: (914) 997-4750
World Wide Web: http://www.modimes.org/

Publication No. (FDA) 98-2306