All pregnant women should be aware of the dangers of Twin to Twin Transfusion Syndrome (TTTS). TTTS is a complication of disproportionate blood supply to twin fetuses during pregnancy. It is critical that all women have an early ultrasound to identify if they are having multiples.

World TTTS Awareness Day is an international mobilization effort created by The Twin to Twin Transfusion Syndrome Foundation to increase awareness of the #1 problem facing multiples. It is crucial for women to get an ultrasound in the first trimester to identify multiples and then to determine whether there is one placenta or two. Women must learn the warning signs of TTTS, the 15 questions to ask at each ultrasound, and the available treatment options. World TTTS Awareness Day is about empowering parents and is filled with messages of Hope, Help and Encouragement. Your babies can make it and be healthy. Don’t ever give up. Please, Get Educated, Get Ultrasounds, Ask Questions, Get Treatment and Get Involved! This day is also a remembrance day for all the babies who have had TTTS. Candles will be lit tonight across the world during the vigil and messages may also be left for your babies through lighting online candles. Please visit their websites to learn more about TTTS.

What is Twin to Twin Transfusion Syndrome?

• Twin to twin transfusion syndrome (TTTS) is a disease of the placenta (or afterbirth) that affects identical twin pregnancies.
• TTTS affects identical twins (or higher multiple gestations), who share a common monochorionic placenta.
• The shared placenta contains abnormal blood vessels, which connect the umbilical cords and circulations of the twins.
• The common placenta may also be shared unequally by the twins, and one twin may have a share too small to provide the necessary nutrients to grow normally or even survive.
• The events in pregnancy that lead to TTTS – the timing of the twinning event, the number and type of connecting vessels, and the way the placenta is shared by the twins are all random events that have no primary prevention, is not hereditary or genetic, nor is it caused by anything the parents did or did not do. TTTS can happen to anyone.

If you are pregnant, what should you do?

Get Ultrasounds

If you are pregnant, it is critical that you get an ultrasound within the first 3 months. With this ultrasound, you can determine if you are having twins, triplets, or even higher order multiples. As early as 7 weeks of pregnancy, it can be determined if you are having multiples. If the placenta is monochorionic, or single, your pregnancy is at risk for TTTS.

Ask Questions

Once you have identified that you are having twins or higher order multiples, it is imortant that you ask questions at each ultrasound. For multiples, ultrasounds should be performed more frequently than in singleton and lower risk pregnancies. Listed below are the TTTS Foundation’s 15 Most Important Questions to ask at each ultrasound.

Confirm at initial ultrasounds (preferably by 10-16 weeks)

1. Is the placenta monochorionic?
2. Are the babies the same gender?
3. Can you see the dividing membrane?
4. Is the placenta implanted on the anterior or posterior surface of the womb?
5. Do the twins’ umbilical cords each have the normal 3 blood vessels, or does one of them have 2 vessels?
6. Are the umbilical cords fully attached to the placenta?

Questions to ask at weekly ultrasounds (16 weeks to delivery)

1. What is the largest vertical pocket of fluid for each baby?
2. Can you see the bladder of the donor baby?
3. What are the weights of the babies in grams? (every 2-3 weeks)
4. Are the dopplers normal for both babies?
5. Is the heart of the recipient baby enlarged or thickened?
6. Does the recipient baby have hydrops?
7. What is the measurement of your cervix, is it long and closed or thinning or dilated?
8. Is the smaller baby growing at the same rate?
9. What is the fundal height?

Read the explanations for these questions at the TTTS Foundation’s website.

PLEASE, get an early ultrasound to determine if you are carrying multiples. If you are pregnant with twins or higher order multiples, PLEASE ask the questions provided by the TTTS Foundation. It could save your babies’ lives. If you are diagnosed with TTTS, or would like more information, please contact the TTTS Foundation for help, information, and support.

Increasing your protein intake is critically important if you are pregnant with twins.

Why Increase Protein intake in your Twin Pregnancy?

• Increase your  chances of carrying to term
• Increase your babies’ birth weight

How much protein do you really need if you are expecting twins?

While recommendations for protein intake for singleton pregnancies are right around 80 grams per day, protein intake recommendations for twin pregnancy are much higher.  Upwards of 130 grams of protein per day is recommended for moms expecting twins, with some researchers recommending more than 170 grams of protein per day for your twin pregnancy.  Beware, out-dated information is still floating around with much lower twin pregnancy protein recommendations.  It is best to check with your doctor for the most current recommendations.  If your doctor recommends less, be sure to dig deeper to understand the recommendation.

Why so much?

Preterm and/or low birth weight babies are much more likely to have health problems at birth resulting in the need to spend time in the NICU (newborn intensive care unit).

Researchers have found that there is a direct correlation between protein intake and weight at birth.  Low protein intake typically results in low birth weight.  For singletons, each 10 gram increase in daily protein intake by mom correlates to 1/2 pound increase in baby’s birth weight.  

What birth weight is considered to be “low”?

According to the March of Dimes, babies born weighing less than 5 pounds, 8 ounces (2,500 grams) are considered to be low birth weight.  These babies are at increased risk for serious health problems as newborns, lasting disabilities and even death.

What are some good sources of protein?

• Lean meats such as Turkey, Chicken (skinned), Pork, and Lean Beef are a great source at an average 7 grams per ounce
• Nuts/Seeds including peanut butter at 4-5 grams per tablespoon; Sunflower Seeds 6 grams 1/4 cup; Pumpkin Seeds 8 grams 1/4 cup
• Milk Products milk 8 oz = 8 grams!, cheese 6-10 grams oz, yogurt 8-12 grams/serving, cottage cheese 1/2 cup=15 grams, powdered whey
• Fish 6 – 10 grams per oz — but don’t overdo tuna as it contains mercury
• Eggs 1 large = 6 grams
• Beans 7 – 10 grams per 1/2 cup / Soy 14 grams 1/2 cup / Tofu 1/2 cup = 20 grams

Any steps you can take to increase your protein intake during your twin pregnancy will pay off — in bigger babies. So go ahead and have another serving of milk or that extra piece of cheese — you’ll enjoy it, your babies will benefit, and so will you!