Preeclampsia in a Twin Pregnancy: Symptoms, Warning Signs, and Treatment

Hearing the word preeclampsia during pregnancy can be frightening, especially if you're expecting twins.

While twin pregnancies have a higher risk of developing preeclampsia than singleton pregnancies, most women do not develop severe complications. The key is recognizing the warning signs and receiving prompt medical care when needed.

Because preeclampsia can affect both you and your babies, your OB or maternal-fetal medicine (MFM) specialist will monitor you closely throughout your pregnancy.

What Is Preeclampsia?

Preeclampsia is a pregnancy complication that causes high blood pressure along with signs that organs, such as the kidneys or liver, may not be functioning normally.

It usually develops after 20 weeks of pregnancy, although it can occasionally occur earlier or even after delivery.

If left untreated, preeclampsia can become serious. Fortunately, regular prenatal care helps providers identify it early in many cases.

Why Are Twin Pregnancies at Higher Risk?

Twin pregnancies place greater demands on the body.

Because there is more placental tissue, the risk of developing preeclampsia is higher than in a singleton pregnancy.

Other risk factors include:

• First pregnancy

• History of preeclampsia

• Chronic high blood pressure

• Diabetes

• Kidney disease

• Autoimmune disorders

• Maternal age 35 or older

• Obesity

Having one or more risk factors does not mean you'll develop preeclampsia. It simply means your provider may monitor you more closely.

What Are the Symptoms?

Some women with preeclampsia feel perfectly well, especially in the early stages. That's one reason regular prenatal appointments are so important.

Possible symptoms include:

• High blood pressure

• Severe or persistent headache

• Vision changes, such as blurred vision, flashing lights, or spots

• Pain in the upper right abdomen or under the ribs

• Sudden swelling of the face or hands

• Rapid weight gain caused by fluid retention

• Shortness of breath

• Nausea or vomiting later in pregnancy

• Decreased urine output

These symptoms can have many causes, but they should never be ignored during pregnancy.

How Is Preeclampsia Diagnosed?

Your provider will consider several factors, including:

• Blood pressure readings

• Urine testing for protein

• Blood tests to evaluate liver and kidney function

• Platelet count

• Your symptoms

• Your babies' well-being

If preeclampsia is suspected, you may need additional monitoring in the office, labor and delivery, or the hospital.

How Does Preeclampsia Affect My Babies?

Preeclampsia can affect how well the placenta works.

If blood flow through the placenta is reduced, babies may not receive enough oxygen and nutrients.

Possible complications include:

• Slower fetal growth

• Low birth weight

• Preterm birth

• Placental abruption (when the placenta separates from the uterus before delivery)

• NICU admission after birth

Your healthcare team will monitor your babies closely with growth ultrasounds, Nonstress Tests (NSTs), Biophysical Profiles (BPPs), or Doppler ultrasounds when appropriate.

What Is HELLP Syndrome?

HELLP syndrome is a severe form of preeclampsia that affects the blood and liver.

HELLP stands for:

• Hemolysis

• ELevated Liver enzymes

• Low Platelets

Symptoms may include:

• Severe upper abdominal pain

• Nausea and vomiting

• Headache

• Feeling generally unwell

• Vision changes

HELLP syndrome is a medical emergency and requires immediate evaluation.

How Is Preeclampsia Treated?

Treatment depends on:

• How far along you are

• How severe the condition is

• Your health

• Your babies' health

Your provider may recommend:

• More frequent prenatal visits

• Home blood pressure monitoring

• Blood tests

• Urine testing

• Growth ultrasounds

• NSTs and BPPs

• Medication to control blood pressure, if appropriate

• Hospitalization for closer monitoring

• Delivery if continuing the pregnancy is no longer the safest option

The only cure for preeclampsia is delivery, but your healthcare team carefully weighs the benefits of continuing the pregnancy against the risks to you and your babies.

What Happens if I'm Diagnosed With Preeclampsia?

If you're diagnosed with preeclampsia, your healthcare team will create a monitoring plan based on how severe your condition is and how far along you are in your pregnancy.

Depending on your situation, you may have:

• More frequent prenatal appointments

• Home blood pressure monitoring

• Regular blood work to monitor your liver, kidneys, and platelet count

• Urine testing

• Growth ultrasounds to monitor your babies' development

• Nonstress Tests (NSTs)

• Biophysical Profiles (BPPs)

• Doppler ultrasounds, if your provider wants to evaluate blood flow to your babies

Some women can be safely monitored at home with close follow-up, while others may need to stay in the hospital for more frequent monitoring and treatment.

Your healthcare team will carefully balance the benefits of continuing your pregnancy with the risks of preeclampsia. If your condition becomes severe or your babies would be safer outside the womb, your provider may recommend delivery.

Although receiving a diagnosis of preeclampsia can feel overwhelming, remember that many women with twin pregnancies go on to have healthy outcomes because the condition is recognized early and monitored closely.

When Should I Call My Provider?

Contact your OB or MFM right away if you experience:

• A severe headache that doesn't improve

• Vision changes

• Severe upper abdominal pain

• Sudden swelling of your face or hands

• Shortness of breath

• Blood pressure readings higher than the range your provider has discussed with you

• Any symptoms that concern you

If your symptoms are severe or you believe you are experiencing a medical emergency, seek emergency medical care immediately.

Can Preeclampsia Be Prevented?

There is no guaranteed way to prevent preeclampsia.

However, some women who are at higher risk, including many with twin pregnancies, may be advised to take low-dose aspirin during pregnancy.

Only take aspirin if your healthcare provider recommends it, since it isn't appropriate for everyone.

Attending all prenatal appointments is one of the best ways to detect preeclampsia early.

My RN & Twin Mom Perspective

As an RN, I've seen how important it is to recognize the warning signs of preeclampsia early. While many women with preeclampsia do very well, ignoring symptoms can allow the condition to become much more serious.

As a twin mom, I also know it's easy to second guess yourself. You may wonder if your headache is just from being tired or if your swelling is simply part of pregnancy. If something feels different or concerning, call your provider. They would much rather evaluate you and find out everything is okay than have you stay home worrying.

💛 Twin Mom Tip

Trust your instincts.

If you develop a severe headache, vision changes, sudden swelling, or simply feel like something isn't right, don't wait until your next appointment. Call your healthcare provider. It's always okay to ask questions when it comes to your health and your babies.

Frequently Asked Questions

Is swelling always a sign of preeclampsia?

No.

Mild swelling is common during pregnancy. However, sudden swelling of the face or hands, especially when accompanied by other symptoms, should be reported to your healthcare provider.

Can I have preeclampsia without symptoms?

Yes.

Some women feel completely well, which is why routine blood pressure checks and urine testing are so important during prenatal care.

Does preeclampsia mean I'll need an early delivery?

Not always.

Some women are safely monitored for weeks before delivery, while others require earlier delivery because the risks of continuing the pregnancy become too high.

Does preeclampsia go away after delivery?

In most cases, blood pressure gradually improves after delivery. However, preeclampsia can sometimes develop or worsen after birth, so continue monitoring your symptoms and attend your postpartum follow-up appointments.

Will I get preeclampsia in a future pregnancy?

Having preeclampsia increases your risk in future pregnancies, but many women go on to have healthy pregnancies with appropriate monitoring.

Related Guides

• Gestational Diabetes in a Twin Pregnancy: Symptoms, Diagnosis, and Treatment

• The Glucose Test During a Twin Pregnancy: What to Expect

• Doppler Ultrasounds During a Twin Pregnancy: What They Measure and Why They're Important

• Biophysical Profile (BPP): What to Expect During a Twin Pregnancy

• Nonstress Test (NST): What to Expect During a Twin Pregnancy

• Twin Pregnancy Growth Scans: What to Expect at Every Ultrasound

• What Is a Maternal-Fetal Medicine (MFM) Doctor?

References

• American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin: Gestational Hypertension and Preeclampsia and patient education resources.

• Society for Maternal-Fetal Medicine (SMFM). Patient education resources on hypertensive disorders of pregnancy.

• Preeclampsia Foundation. Educational resources for patients and families.

• Centers for Disease Control and Prevention (CDC). High blood pressure during pregnancy.

Medical Disclaimer

This article is for educational purposes only and should not replace medical advice from your healthcare provider. Always consult your OB, maternal-fetal medicine specialist, or another qualified healthcare professional with questions about preeclampsia, pregnancy symptoms, or your medical care.