Triplet pregnancy: What do we tell the prospective parents

Abstract

Experience managing triplet pregnancies has increased over the past few decades as the incidence has changed related to assisted reproductive practices. Physicians caring for women carrying triplets cannot predict an individual outcome or pregnancy course but must educate patients about the challenges related to these high risk pregnancies. Obstetric providers can describe the wide range of risks associated with triplet gestations, and the general plan for management, but ultimately parents must make decisions with potentially lifelong consequences. Here, we present the diagnostic criteria, common complications, and management options for triplet pregnancies, to help obstetricians counsel patients on the medical and psychosocial consequences of triplet pregnancy, potential complications, and multifetal reduction.

Qualitative Investigation into Pre- and Post-Natal Experience of Parents of Triplets

“…One original contribution of this study was an appraisal of the first-hand experiences in parents of triplets to address the lack of mental health care for parents of triplets (Bricker, 2014 ). Consistent with previous triplet studies (Baor & Blickstein, 2005 ; Mhatre & Craigo, 2020 ), our participants reported experiencing mental distress associated with psychological and financial impact of having triplets, and health concerns of arriving babies and the mother. Emotional words such as ‘anxious’, ‘worried’, ‘stressed’, ‘panicked’, and ‘excruciating’ were often used to describe the psychological status during the prenatal and postnatal phases.…”

“…Emotional words such as ‘anxious’, ‘worried’, ‘stressed’, ‘panicked’, and ‘excruciating’ were often used to describe the psychological status during the prenatal and postnatal phases. These pieces of data can further illustrate the emotional life of parents, elucidating the previously identified risk factors in parents of triplets, such as reduced quality of life (Roca-de-Bes et al, 2011 ) and emotional exhaustion (Mhatre & Craigo, 2020 ). As recommended by Roca-de Bes et al ( 2011 ), if psychotherapy is used for parents of triplets, intervention targeting these emotions may be particularly effective.…”

“…Although there are many studies assessing the external factors such as risks, outcomes and management of triplet pregnancies (Mhatre & Craigo, 2020 ), there is a paucity of research available on the internal experience of parents of triplets, following from pre- to post-natal phases. Accordingly, this study aims to understand the first-hand experience of parents of triplets through qualitative investigation.…”

“…For those who used ART and IVF, it is likely that families with triplet pregnancies experienced difficulties with infertility, which is often associated with anxiety and emotional distress (Baor & Blickstein, 2005 ). As there are significant risks involved in a triplet pregnancy, the decision to continue a pregnancy can result in short-term and long-term stress and anxiety (e.g., decision to decline doctor’s suggestions for selective reduction; Mhatre & Craigo, 2020 ). Subsequently, this heightened anxiety highlights a need for clinicians to provide specific mental health support and information during pregnancy (Bricker, 2014 ).…”

“…Although this decreases childcare costs, the reduced income can significantly contribute to the household financial strain (Glazebrook et al, 2004 ; Strauss et al, 2008 ). In addition to the economic burden of caring for triplets, parents often experience considerable physical and emotional exhaustion (Mhatre & Craigo, 2020 ). It has been suggested that mothers of triplets are more likely, than mothers of singletons, to experience feelings of tiredness, stress and depression (Ellison et al, 2005 ).…”