The National Institute for Health and Clinical Excellence (NICE) has issued new guidelines saying that women pregnant with twins or triplets should be monitored more closely, receiving specialist care from a team of healthcare professionals.
Multiple births have increased greatly in recent years, from 10 per 1,000 in 1980 to 16 per 1,000 in 2009. They now account for three percent of the total live births in England and Wales each year. This has been attributed to an increase in the successful use of assisted reproduction methods, such as IVF.
'This is the first time NICE has published recommendations for healthcare professionals on managing multiple pregnancy, based on the best available evidence', said Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE. 'Implementing these clear recommendations will help women to feel supported and well looked after at a time when they can be feeling very anxious'.
According to NICE, women should receive no fewer than six scans, and be offered emotional support and information on topics including preterm labour and breastfeeding, by a range of healthcare professionals who are used to dealing with multiple pregnancies.
Dr Virginia Beckett, from the Royal College of Obstetricians and Gynaecologists, told the BBC: 'A multi-disciplinary approach including input from midwives, obstetricians and ultrasonographers will help ensure any complications are picked up early'.
Dr Macbeth added: 'Although many women will have a normal pregnancy and birth, it is well known that there are higher risks involved for these types of pregnancy and so it is important to get it right'.
These risks include complications with the pregnancy — from vaginal bleeding to miscarriage or preterm delivery — and dangers to the babies themselves, with low birth weights being more common in children from multiple pregnancies. According to NICE, the rate of stillbirth in women with multiple pregnancies is 2.5 times higher than in those expecting one child.
One of the motivations for implementing such recommendations is the disparities in such services throughout England and Wales. 'Although much of the care at present is very good, there are many inconsistencies and often poor coordination between healthcare professionals if mothers are referred to other hospitals', explained Jane Denton, Director of the Multiple Births Foundation, referring to the guidance as a 'significant milestone in the management of multiple pregnancies'.
The recommendations, which only considers twin and triplet pregnancies, recommend up to 11 scans, and a scan between 11 and 14 weeks to establish if the siblings share a placenta, which can increase the risk of complications. Furthermore, despite the fact that currently many women at risk of early labour are offered bed rest or drugs to prevent labour, NICE does not recommend these as routine, as there is no evidence they are effective at preventing early labour.
Mark Kilby, Guideline Development Group Chair and Professor of Fetal Medicine, University of Birmingham and Birmingham Women's Hospital, said: 'If followed correctly, these new guidelines will result in fewer preterm births and neonatal complications, by providing mums-to-be with the highest quality of care'.