This article originally appeared on health.
In the middle of all the headline-grabbing political news, Beyoncé stole everyone’s attention by announcing she’s pregnant—with twins!
The performer posted a photo of her growing bump on Instagram. “We would like to share our love and happiness,” the performer wrote. “We have been blessed two times over. We are incredibly grateful that our family will be growing by two, and we thank you for your well wishes.”
Every mother knows those nine months of waiting are full of excitement, mood swings, perhaps a few cravings and some physical discomfort—and according to Barak Rosenn, MD, director of obstetrics and maternal-fetal medicine in the Department of Obstetrics and Gynecology at Mount Sinai St. Luke’s and Mount Sinai West, most moms who find they’re carrying twins are perhaps twice as thrilled. “They’re usually very excited, so I want to make sure they know the risks, too,” Dr. Rosenn says. “When you’re ready, they’re easier to handle.”
So, what’s it like carrying twins as opposed to just one baby? Here are some things Beyoncé, and other expectant moms, can anticipate carrying two bundles of joy.
A twin pregnancy requires an extra 600 calories per day
According to the American Congress of Obstetricians and Gynecologists (ACOG), it’s typically recommended that you consume 300 calories per day, per child, above your typical calorie intake—so that means about an extra 600 calories for twins. This should equate to an extra 10 to 15 pounds of weight for twin moms of normal BMI, on top of the standard 25 to 35 pounds for an expectant mom of one (roughly 35 to 45 pounds).
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According to Michael Cackovic, MD, a maternal-fetal medicine physician at The Ohio State University Wexner Medical Center, a mom-to-be of two should focus on eating healthy and feeling satisfied first and foremost, because 600 calories per day feels like more than it is. He also recommends an additional 1 milligram of folic acid for the pre-baby diet. “I just had a mother of twins ask if she needed to double prenatal vitamins, and the answer is no,” Dr. Cakovic says. “Just extra folic acid, otherwise the regular prenatal vitamin ritual should do.”
Twin mothers have a higher risk of certain pregnancy-related conditions
The biggest risk of twin pregnancy is preterm labor, according to Dr. Rosenn, but mothers of twins are also at risk for other conditions. “They have about twice the risk of preeclampsia, and a higher risk of gestational diabetes,” Dr. Rosenn says. With twins, a pregnant mother should expect more doctors visits and ultrasounds to monitor fetal progress and mom’s health.
Morning sickness and pregnancy symptoms with twins may be more severe
A mom of twins might see more severe morning sickness symptoms with twins, and earlier in the gestation period. “Before we had ultrasounds, increased morning sickness was actually one of the first signs that a woman might be expecting twins,” says Dr. Cakovic. According to the ACOG, you also might experience more breast tenderness and faster weight gain with twins. Dr. Cakovic says doctors typically measure advancing gestation in weeks, and a mother carrying twins might appear the equivalent of six weeks farther along in her pregnancy at any given time than a mother carrying one.
Twin moms’ hearts are working harder during pregnancy
With that extra weight gain and extra load up front, moms who are expecting twins may feel slower and heavier, and their center of gravity may be more dramatically off-kilter. In addition, Dr. Rosenn says blood volume can increase by up to 70% during a twin pregnancy. “This means your heart is working harder; it almost feels like you’re exercising,” Dr. Rosenn explains. “It is a bigger physical burden in more than one way… Very often, women feel they can’t work as much, and may cut their work hours around six or seven months.” The doctor says a mom-to-be may find it difficult to climb stairs, fall asleep, and do a number of other tasks, so she needs to listen to her body about how much rest feels warranted.
Mothers pregnant with twins should deliver around 36 to 37 weeks instead of 40
Most women don’t carry twins to term in an attempt to prevent stillbirth, but the timing of delivery has never been well-established in medical literature. A 2016 meta-analysis looked at birth studies conducted over the past 10 years, including some 35,000 twin pregnancies, in an attempt to find the best window of time to deliver two babies with two placentas. Researchers found that 37 weeks seems to be the sweet spot for twins with two placentas (the most common twin pregnancy); the risk of newborn death (defined as death up to four weeks after delivery) and stillbirth was roughly even until 37 weeks, which is when the risks of pregnancy start to outweigh the benefits and a mother should consider delivering.
Indeed, Dr. Cakovic says twin moms usually deliver between 36 and 37 weeks if everything is going well. For pregnancies where the twins shared one placenta, the magic number in the study was 36 weeks, but Dr. Cakovic says some doctors may deliver as early as 34 weeks. Overall, it’s best for a pregnant woman to make a plan with her own ob/gyn; delivery timing will vary from mom to mom, the type of twin pregnancy, and how the babies are each developing.
A mother of twins should find a team of docs who can perform the type of birth she wants
Although you might think twin pregnancies require c-sections, they actually don’t, says Dr. Rosenn, who cites a large 2013 study published in the New England Journal of Medicine. Researchers found there was no significant difference in the outcomes of planned-vaginal deliveries and planned-cesarean deliveries. “You can deliver vaginally if the first baby comes with the head down,” says Dr. Rosenn. “But it’s best to find a team of doctors who know how to handle the second twin.” If a twin mother prefers to try a vaginal delivery over a c-section, she should ask her docs if they’re comfortable with natural birth.
So, congrats to the Carters on twins! Now, all eyes will be waiting to see if Bey is carrying two boys, two girls, or one of each. Let the guessing games begin.