Common Complications of Preterm Twins

Joe Rawlinson by Joe Rawlinson - April 25, 2017

Heather asked: “What are some of the most common complications or problems with pre-term twins?”

Common Complications of Preterm Twins

Timing of Arrival

Premature twins babies are typically born between 34 and 37 weeks, and they generally do very well. On average your twins are going to be born in this range. However, babies can be born, especially twins, well before 34 weeks. If your babies are going to be born before 28 weeks, they may survive but there’s going to need to be intensive medical care for that to happen.


The major complications with pre-term twins are going to be that they’re not quite ready to survive on their own in the real world outside of mom. So their lungs, their brain, other organs may not be fully developed, and their immune system may not be ready to fight off infections. They may not even be able to suck or to swallow with their mouth. And oftentimes these reasons are why premature twins spend time in the NICU, the neonatal intensive care unit.

Pre-term Labor

According to the American College of Obstetricians and Gynecologists, the most common complication of a twin pregnancy is going to be pre-term labor and pre-term birth.

Technically, pre-term labor is labor that starts before the end of 36 weeks of pregnancy, but with twins this is very common. For example, our girls were born at 36 weeks, which is by itself pre-term labor and pre-term delivery. Keep in mind that more than half of all twins are born pre-term.

Early Arrivals and the NICU

The odds are pretty much in your favor that they’re going to come early, and definitely earlier than the 40 weeks that is typical of singleton babies. Because of their early arrival, pre-term twins are going to have to spend some time in the NICU until they can meet certain key milestones that enable them to have a great chance of success in life outside of the hospital.

Your twins won’t be able to leave the NICU until they are able to meet key milestones.

According to the March of Dimes, these include the ability to keep yourself warm, that your baby is able to sleep in a crib and not in an incubator, your baby needs to weigh four pounds or more. Your babies need to learn how to breast or bottle fed by themselves. Oftentimes, very premature babies in the NICU need IVs to get their nourishment. They’ll need to be able to move past that and feed themselves before they can leave. Your babies need to breathe on their own without a respirator.

When Pre-term Labor Happens

If mom’s going into pre-term labor, there are some things that can happen to help prevent that and make sure the babies stay in mom a little bit longer to get ready for life on earth. If you go into pre-term labor, your doctor may give you a steroid shot. This drug helps the babies’ lungs mature and helps prepare them for delivery.

Make sure that you’re consulting with your doctor throughout the pregnancy to make sure that you are maintaining a healthy lifestyle that will enable your twins to stay in the womb as long as possible so they can develop in that safe environment.

My wife, for example, ended up on partial bed rest towards the end of the twin pregnancy. We feel that helped keep the babies in longer than they would have otherwise.

This question was originally addressed on the Dad’s Guide to Twins Podcast Episode 61: Preterm Twin Complications, Long Naps, Mobility Concerns.

(RELATED: Your twins will need a lot of gear. Here's the complete twins baby registry checklist to get ready for your twins' arrival.

Further Reading

Dad's Guide to Raising Twins book
Don't forget to pick up a copy of the definitive guide to raising twins. "Dad's Guide to Raising Twins" was written for fathers of twins to help guide you through the first several years with twins. Click here to learn more about the book and get your copy.

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