Twin pregnancy in Nigeria

By: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health).

Medically reviewed by: ‘Kunle Soyemi. MBBS, FWACS; FRCOG. Consultant Obstetrician & Gynaecologist.

 

A black pregnant lady wearing stripped dress sitting on a couch in a doctor’s office cupping her abdomen with both hands. Image credit: Freepik

 

Highlights:

• Nigeria has the highest twin birth rate globally, particularly in the Yoruba ethnic group.

• Fraternal twins are more common than identical twins.

• Factors like race, family history, and fertility treatments increase twin pregnancy chances.

• Twin pregnancies have higher risks of complications such as prematurity, poor baby growth, hypertension, Caesarean section, bleeding after delivery and increased risk of newborn admission and death.

• Twin pregnancies are high-risk and require specialised medical care.

• Proper antenatal care, nutrition, and post-delivery support are essential for a healthy twin pregnancy, safe delivery and a post-delivery period

 

Introduction

The usual prayer during wedding ceremonies in Nigeria is for the couple to have sets of twins. Though twin pregnancies are sometimes associated with problems, they are desired in many Nigerian societies.

Twin pregnancies refer to the presence of two babies in the womb. This usually results from events that occur during and after the fertilization of the egg by the sperm.

Nigeria is recorded to have the highest number of twins in the world, though the reasons for this are not yet well explained. [1, 2]

When successfully born, twins bring a lot of joy to the family and community. However, due to the challenges associated with managing these pregnancies, mothers require special care during pregnancy. Beyond pregnancy and childbirth, the financial burden of raising twins is also a challenge. This may lead to an increased risk of childhood illnesses or social deprivation, such as a lack of education.

This article aims to discuss twin pregnancies in Nigeria and how to ensure a safe pregnancy and delivery.

 

How does twin pregnancy develop?

 

Black twin babies lying on a bed and playing with toys. Image credit: Freepik.

 

Twin pregnancies result from the fertilization and division process.

When a man has intercourse with a woman, the deposited sperm meets the egg in the fallopian tube, where fertilization occurs. This results in the formation of the embryo.

The specific process around the time of ovulation determines the type of twin pregnancy.

Twins can be classified into two (2) main categories depending on the number of eggs fertilised at the time of conception. These categories include:

• Dizygotic (Fraternal)
• Monozygotic (Identical)

Fraternal twins result from the fertilization of two eggs by two different sperms. About 70% of twins are fraternal. 

Monozygotic pregnancies occur when an already fertilized egg divides into two.

While the highest number of twin pregnancies in the world is found in southwestern Nigeria, the distribution of identical twins is the same worldwide.

In terms of the number of placentas and sacs, twin pregnancies are classified into three types:

• Dichorionic diamniotic: Separate placenta and sacs
• Monochorionic diamniotic: Shared placenta but separate sacs
• Monochorionic monoamniotic: Shared placenta and sac

In this context, chorionic refers to the placenta, while amniotic refers to the sacs.

While fraternal twins always have separate placentas and sacs, identical twins can have any of the three combinations, depending on how (when) the embryo divides. If the division occurs after 12 days of fertilization, the twins may even be conjoined. This is very rare,. however

Because monochorionic monoamniotic twins share both the placenta and the sac, this type of twin pregnancy carries the highest risk of complications.

 

What increases your chances of having twin pregnancies?

Some factors influence the likelihood of having twins. These include:

 Race

• People from the Yoruba ethnic group in Nigeria have an increased chance of having twins. [3]
• The highest recorded rate in the world is 45 to 50  per 1,000 live births in Igbo-Ora, a community in southwestern Nigeria.

 Family history

• If a woman has a family history of twins, her chances of having a twin pregnancy increase.

 Age

• Although fertility declines after age 35, women above this age have a higher likelihood of releasing more than one egg, increasing the chances of a twin pregnancy.

 Assisted reproduction

• The use of fertility drugs to stimulate ovulation can lead to the release of multiple eggs, increasing the risk of twin pregnancies.
• In assisted reproductive techniques like in-vitro fertilisation(IVF), multiple embryos are often transferred, further raising the chances of twins.

Other less-known factors

• Diet: Some foods may influence the likelihood of twin pregnancies. A particular white yam species, Dioscorea rotundata, commonly eaten in southwestern Nigeria, is believed to increase the likelihood of twin pregnancies. [2]  Other local delicacies have been suspected, but there is no concrete scientific evidence to support their link to twin births.
• Low socioeconomic status: Some studies suggest a correlation, but the exact mechanism is unclear.
• Higher parity: Women who have given birth multiple times have an increased chance of conceiving twins.
• Increased maternal body mass: Taller and heavier women are more likely to have twins.

 

What to expect during a twin pregnancy

Though a twin pregnancy may begin like a single-baby pregnancy, it comes with challenges that may not occur if only one baby were present. With each additional baby, the risks of pregnancy increase. 

A study in Southeastern Nigeria found that twin pregnancies have a higher risk of low birth weight, early water breaking, stillbirth, newborn death, high blood pressure during pregnancy, and cesarean delivery compared to pregnancies with one baby. [4] Because of this, a twin pregnancy is considered high-risk due to the potential complications that may arise along the way. 

This notwithstanding, twin pregnancies may progress without challenges.

 

Common symptoms of twin pregnancy

In a twin pregnancy, some typical pregnancy symptoms are exaggerated. These include:

• Increased nausea and vomiting
• Greater fatigue
• More frequent episodes of back pain due to an enlarged womb
• Increased difficulty with walking
•  Increased abdominal size and discomfort
• More rapid increase in weight

Because of these risks, it is essential to register for antenatal care at a hospital with qualified healthcare professionals and to attend all antenatal clinic appointments.

This will help your healthcare provider detect any problems early and take the necessary steps to manage them.

Though a twin pregnancy may start like a pregnancy involving only one baby, there may be challenges that may not occur if there is only one baby.   

 

Complications of twin pregnancy

Though a twin pregnancy may progress without any issues, it is often associated with complications in either the mother or the babies. [5-8]

These problems can occur during:

• Pregnancy
• Labour
• After delivery

Complications in the mother

Complications in the mother can include:

• Exaggerated symptoms of pregnancy
• Higher risk of miscarriage
• Increased risk of anaemia
• Greater risk of hypertension (elevated blood pressure) during pregnancy
• Elevated risk of diabetes (increased blood sugar) during pregnancy
• Increased likelihood of infections in the urinary organs (due to higher pregnancy hormones and pressure from the growing uterus on urinary organs)
• Higher risk of low-lying placenta (placenta previa)
• Increased risk of premature placental separation (abruptio placenta)
• Higher chances of requiring a caesarean section (operation for the delivery of the baby)
• Greater risk of bleeding after delivery
• Increased risk of depression after delivery (often due to the stress of caring for two babies)

Complications in the babies

The babies are also at higher risk for the following complications: [8]

• Increased risk of prematurity: About 60% of twin babies are born before full term, making prematurity the most common complication of twin gestation.
• Higher risk of stillbirth
• Increased risk of congenital abnormalities, such as Down syndrome
• Higher risk of twin-to-twin transfusion syndrome, particularly in identical twins (this occurs when blood flows from one twin to the other due to a shared placenta and abnormal connection between the blood vessels feeding the two babies( anastomoses))
• Greater risk of neonatal death, usually due to prematurity
• Increased likelihood of needing admission to the neonatal intensive care unit (NICU), often due to complications related to prematurity
• Higher risk of long-term complications, such as cerebral palsy

 

Factors associated with prematurity in twin pregnancy

Several factors contribute to the increased risk of prematurity in twin pregnancies, including: [3]

• Preterm labour( onset of labour before maturity)
• Premature rupture of membranes (water breaking)
• Fetal growth restriction (poor growth of the baby in the womb)
• Congenital anomalies(inborn problems) in the baby
• Fetal distress (abnormal heart rate of the unborn baby)
• Complications in the mother such as hypertension, diabetes, and bleeding due to problems in the placenta.

 

How to care for yourself during a twin pregnancy

Due to the risks associated with twin gestation, more frequent surveillance is required during pregnancy.

• Early ultrasound scan: It is recommended around 11-14 weeks. An early ultrasound helps determine the number of placentas and sacs. This information aids in better management, as babies with one placenta and sac will require more monitoring and care.
• Detection of anomalies: Diseases like Down’s syndrome can be suspected through early scans.
• Antenatal care registration: It is important to register for antenatal care at a health facility equipped to manage high-risk pregnancies.
• Balanced diet: A balanced diet is essential to meet the nutritional needs for the growth of two babies.
• Iron and folic acid supplements: Taking these supplements is important to prevent anaemia.
• Frequent scans and appointments: More frequent scans and check-ups may be necessary, so it’s crucial to keep all your appointments.
• Understanding the delivery plan: In twin pregnancies, a caesarean section may be needed if:
  • The first baby is not in a head-down position.
  • There are congenital anomalies that could make delivery difficult.
  • The babies share one sac (to reduce the risk of umbilical cord entanglement, i.e., knotting of the umbilical cord) 
  • There are other complications in the mother or babies, such as hypertension, fetal distress, or poor growth of the baby.
  • Problems arise during labour.

You need to understand your doctor's plan ahead of delivery.

Planning for delivery

It is important to plan for delivery by:

• Choosing the appropriate place to deliver.
• Ensuring funds are available for delivery-related expenses.
• Arranging for additional help in caring for the babies.

Coping after a twin delivery

• The presence of an additional baby places a strain on the mother and the family. It also requires a higher financial investment, so it's important to be prepared for this.
• If your babies are not born prematurely, you will typically be observed in the hospital for up to 24 hours and discharged if all is well.
• However, most babies from twin pregnancies are born prematurely, so they may need to be admitted to the NICU, which will require an extended hospital stay for the babies' care. You may also choose to stay at the hospital to care for them if that is your preferred option.
• Once discharged, you will need extra help at home, so make arrangements for this in advance. Close family members can be very supportive during this time.
• Make sure to eat well and stay active as your body recovers from the twin pregnancy and delivery. If you had a cesarean section, the recovery period may take a bit longer.
• Breastfeeding two babies can be challenging but is certainly possible. Exclusive breastfeeding is highly recommended. Try to nurse each baby on both breasts. If necessary, supplemental feeding may be required, with expressed milk for one or both babies.
• Feeding both babies at the same time can help with time management. Take advantage of the babies' sleep periods to get enough rest.
• In addition to feeding, you will need to attend to other aspects of baby care, such as managing the umbilical cord and ensuring proper immunization.
• Pay attention to your mood, and if you feel overwhelmed, don't hesitate to speak to your healthcare provider.
• Finally, make sure to return to the hospital with your babies for evaluations at six weeks. Your doctor may schedule an earlier appointment depending on your circumstances.

 

Conclusion

In Nigerian society, having more children is considered desirable for numerous socio-cultural reasons. Therefore, twin births are often highly desired. However, given the potential complications, your pregnancy will require close monitoring at a hospital with the necessary facilities. You also need to gather all the necessary resources, like money and extra help, to care of the twins at birth

 

References:

1. Omonkhua AA, Okonofua FE, Ntoimo LFC, Aruomaren AI, Adebayo AM, Nwuba R. Community perceptions on causes of high dizygotic twinning rate in Igbo-Ora, South-west Nigeria A qualitative study. PLoS One. 2020;15(12):e0243169.Available from here. 

2. Igbodike EP, Ijarotimi OA, Ubom AE, Eleje GU, God’swill CC, Okpala BC, et al. Trends and outcomes of twin births in southwest Nigeria: a 14-year retrospective cohort study. Explor Res Hypothesis Med. 2024;9(1):15-24. doi: 10.14218/ERHM.2023.00039. Available from here. 

3. Ibrahim I, Oyeyemi A, Obilahi A. Twin pregnancies in the Niger Delta of Nigeria: a four-year review. Int J Womens Health. 2012;4:245–9. doi: 10.2147/IJWH.S31350. Available from here.

4. Obiechina N, Okolie V, Eleje G, Okechukwu Z, Anemeje O. Twin versus singleton pregnancies: the incidence, pregnancy complications, and obstetric outcomes in a Nigerian tertiary hospital. Int J Womens Health [Internet]. 2011;3:227–30. Available from here. 

5. Santana DS, Surita FG, Cecatti JG. Multiple pregnancy: epidemiology and association with maternal and perinatal morbidity. Rev Bras Ginecol Obstet. 2018;40(9):554–62. doi: 10.1055/s-0038-1668117. Available from here.

6. Esteves-Pereira AP, da Cunha AJLA, Nakamura-Pereira M, Moreira ME, Domingues RMSM, Viellas EF, Leal MDC, Granado Nogueira da Gama S. Twin pregnancy and perinatal outcomes: Data from 'Birth in Brazil Study'. PLoS One. 2021 Jan 11;16(1):e0245152. doi: 10.1371/journal.pone.0245152. Available from here.

7. Santana DS, Silveira C, Costa ML, Souza RT, Surita FG, Souza JP, et al. Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health. BMC Pregnancy and Childbirth. 2018;18(1):449. doi.org/10.1186/s12884-018-2082-9. Available from here. 

8. Getachew T, Negash A, Debella A, Yadeta E, Lemi M, Balis B, et al. Prevalence and adverse outcomes of twin pregnancy in Eastern Africa: a systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2024;24(1):169. doi.org/10.1186/s12884-024-06326-0. Available from here. 

 

Related: 

• Essential Guide to Labour for African Women and Men
• What Africans Need to Know about Antenatal Care
• Why African women die more from birth-related bleeding
• Causes and Risk Factors of Hypertension in Pregnancy in sub-Saharan Africa
• Social Factors Shaping African Women’s Health

 

 

Published: March 7, 2025

© 2025. Datelinehealth Africa Inc. All rights reserved.

Permission is given to copy, use and share content freely for non-commercial purposes without alteration or modification and subject to source attribution.