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Is it true that the symptoms of pregnancy are worse with twins?

They definitely can be worse, but that's not always the case. Women who are pregnant with twins are more likely to have severe symptoms, particularly a bad case of morning sickness. Other common problems include an inability to sleep, fatigue, general discomfort and pain, water retention and swollen legs, nausea, and problems moving about easily.

Jennifer Kosko of Burke, Virginia, had such severe morning sickness when she was pregnant with her twins that she developed a condition known as hyperemesis, or excessive nausea and vomiting. She had to be hospitalized and put on an IV to replenish her body's fluids. But she's not convinced it was being pregnant with twins that made her so sick, since she also had severe morning sickness with her first pregnancy, a single baby.

I'm considering genetic testing because I'm over 35. Is it safe with twins?

Genetic testing is definitely worth discussing with your healthcare provider or a genetic counselor, if you have access to one. You may even be referred for genetic testing if the results of an ultrasound or triple marker screens seem suspicious, if you're over age 35, or if you have a family history of a chromosomal defect.

Genetic tests will be run on samples of your amniotic fluid, or, if you have a CVS, on chorionic villi — tiny fingerlike projections on the placenta. These samples are full of genetic information that can be analyzed to reveal the chromosomal makeup and the sex of your baby. Although the decision to undergo such testing is never easy, you may find some comfort in knowing about any problems with the fetuses early on.

The facts are these: The risk of birth defects in each twin is nearly double what it would be if you were pregnant with just one baby, and if you're older, your chances of carrying a baby with an abnormality are higher still. Performing certain tests can be more risky with twins because the test itself could cause you to end up miscarrying one or both babies.

If you do decide to undergo invasive testing, make sure a doctor experienced with performing the test on twin pregnancies does the procedure.

What are the chances that I'll deliver prematurely? If I do, what are the risks for the babies?

Women go into preterm labor (which generally means before 37 weeks) in nearly half of twin pregnancies, far more often than do women carrying only one baby. Overall, about one-third of women pregnant with twins who go into preterm labor end up delivering early. That's why many women strive to reach 38 weeks, considered full-term in a twin pregnancy, to increase the odds that their babies will be born mature. The earlier the babies are born, the less twins are likely to weigh, and the less they weigh, the greater their chances of health problems.

What are the chances I'll be put on bedrest?

If you develop complications such as preterm labor, you'll probably be put on bedrest, even though no research proves that bedrest will prevent a preterm delivery. If your pregnancy is going smoothly, your healthcare provider's attitude and approach will dictate whether you'll be put on bedrest. By early in the third trimester, most doctors or midwives advise taking it easy. Quite a few recommend bedrest for the remainder of the pregnancy.

If you are put on bedrest, clarify exactly what that means because the definition can vary from slightly curtailing your activity to literally not getting out of bed for any reason — and everything in between. Click here for Questions to Ask About Bedrest so you'll know exactly what to expect.

Jennifer Kosko was hospitalized when she began having preterm contractions at 32 weeks. Then her doctor put her on strict bedrest 23 hours a day. "I took a five-minute shower and went to the bathroom, then I would dry my hair while lying down in bed," she recalls. Six weeks later, she gave birth by cesarean-section to healthy fraternal twins weighing nearly 6 and 7 pounds a piece.

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