Link Copied

A link has been copied to your clipboard!

All about Quadruplets

Feb 22, 2022 | 2 Minutes Read

Multiple births always attract attention and there is generally a great deal of fascination about the concept of more than one baby being born at the same time. But for parents of quadruplets, their initial responses can be far from what can be called exuberance, at least in the early stages.

The practicalities of raising four babies to adulthood can seem utterly overwhelming, which is why experienced parents of higher order multiples (HOM) say it can help to just take things slowly at first and to allow the news to settle in, one steady day at a time.

The most common form of multiples are twins. Statistically 90% of all multiple births are made up of twins and the remaining 10% are shared between triplets, quadruplets and more. The most common variety of quadruplets is formed when 4 separate eggs are fertilized by 4 separate sperm. There are, however, a range of possibilities when it comes to the different combinations of quadruplets and how they are conceived. Quadruplets may be identical, non-identical or a combination of both.

As well as the 4 separate eggs and sperm variety, there is also the possibility that:

  • One fertilized egg split into 4 identical embryos.
  • One fertilized egg split into 3 identical embryos and another separate egg is fertilized by a separate sperm. This means there are identical triplets plus one.
  • One set of identical (monozygotic) twins occurs, plus another 2 entirely separate embryos or another set of identical twins.
  • Another possibility is that a set of non-identical or fraternal twins is conceived, plus a monozygotic pair form making a total of 4 embryos.
Quadruplet pregnancy is usually diagnosed on ultrasound. This is the most common time for parents to be told that 4 babies have been conceived and implanted. Seeing 4 little embryos on the screen can help the idea become a reality, but it’s very normal for expectant parents to leave the ultrasound rooms in a state of shock. If they have had fertility assistance, then there is an increased risk of multiple birth so the possibility may already have been raised and discussed. Although rare, it is not unknown for quadruplets to be naturally conceived.

Tell us again how lucky we are!

Different cultures view multiple births in diverse ways. For the Mayans, identical twins were seen as a blessing from God and a sign that they shared one soul which had been split between the two. In Roman culture twin boys were also viewed as a blessing, but unfortunately this belief did not extend to twin girls. They were seen as too much of a burden and the expense of raising 2 dowries instead of one overshadowed the specialness of two babies.

Within Greek and other European mythology, twins and other higher order multiples all appear, with their existence being attributable to the blessing or, alternately, a curse from an almighty God.

In some ancient cultures, multiple births were seen as an outward sign that a woman had been unfaithful to her husband and the existence of more than one baby was indisputable proof of this. Without any means of disproving this theory the poor women and their babies were often left to fend for themselves.

It goes without saying that we have much to be thankful for in terms of our current understanding of science and reproductive biology. But no matter how smart we have become, and irrefutable evidence now supports our knowledge, there is still a little mystery and specialness surrounding multiple births.

Are quads as common as they used to be?

In the 1980s and 1990s, multiple pregnancies were generally more common than at the present time. This decrease is thought to be due to overall advances in technology surrounding fertility assistance as well as the increased likelihood of these pregnancies being successful.

In the early days of assisted reproductive technology the general approach was to implant as many fertilized eggs as possible and therefore increase the chances of at least one of them implanting. But since there has been a greater understanding of the processes involved, as well as changes in the regulations surrounding the numbers of embryos which can be implanted, this has meant a reduction in the number of quadruplets being born.

There is an increased likelihood of quadruplets when:

  • A mother has a family history of multiple births. If she is a multiple herself or her mother and or sisters naturally conceived multiple babies, then she is more likely to as well. This is because there is a genetic link of hyperovulation among the women in some families.
  • Couples who have had fertility assistance. Medication which increases the number of eggs supported towards maturity will increase the chances of multiple conception.
  • Women whose diet is high in dairy foods and yams or sweet potatoes.
  • Women of African, especially Nigerian, descent.
  • Women who are already breastfeeding an older baby or toddler. These women are more likely to conceive with multiples. Lactation and frequent breastfeeding can also have a contraceptive effect by stopping ovulation, so this is a very individual situation.
  • Couples have regular sex during the woman’s fertile phases. This increases the overall chances of conception occurring.
  • A woman conceives in her first cycle after ceasing the contraceptive pill. This is a time when her body is going through a readjustment phase of ovulation and menstruation, and it can take a few months for her body to align back to a normal reproductive cycle.
  • Women who are taller and have a higher Body Mass Index (BMI). This can also have a reverse effect, as women who are overweight can also have problems with regular ovulation.
  • Women who are older when they conceive rather than in a younger age group. Research has shown that women who are over 35 years are more likely to conceive with multiples. This tendency is thought to be due to what is known as a fertility spike, which occurs in women just before they enter perimenopause. From a biological perspective, this is probably due to the naturally occurring phenomenon of nature maximizing the number of babies which can be born while women are still fertile.
  • A woman who has had many previous pregnancies. The more babies she has had and the more times she has ovulated, the more likely she is to naturally conceive with multiples. This includes quadruplets.

Risks of quadruplet pregnancy

Risks to the mother include:
  • Miscarrying one or all the quadruplets. Genetic abnormalities account for a large percentage of early-stage miscarriage. Even in a singleton pregnancy, the chances of miscarriage are 10 to 25% and these odds are increased for multiples.
  • Increased risks of pregnancy complications overall including gestational diabetes, hypertension, placenta previa, ante and postpartum hemorrhage, and anemia.
  • Uterine rupture and placental abruption.
  • Need for Cesarean delivery. A normal vaginal delivery is not advisable for the birth of quadruplets as it is too stressful and risky for both the mother and her babies.
  • Access to tertiary-level neonatal services is essential. Women who are pregnant with quadruplets and who live in rural or regional areas are usually advised to relocate in their second or third trimester at the latest so they are close to the major city maternity hospital where their quads will be born.
  • Restrictions around lifestyle, work, household, and care of older children if there are any. The usual recommendations around working during pregnancy and taking maternity leave are different in the case of multiple pregnancy.
  • Greater likelihood of having postpartum depression and psychological adjustment disorders after the babies are born. Additional stress on the parent’s relationship is inevitable and the need for practical, financial, and emotional support is great.
Risks to babies include:
  • Premature birth, which is always a risk factor in multiple births.
  • Intrauterine growth restriction and low birth weight. The average weight for a preterm individual quadruplet is around 3 pounds but many weigh less than this and do not exceed a little over 2 pounds when they are born.
  • Cerebral palsy and jaundice. The babies may need blood transfusions if there have been incompatibility issues or in cases of anemia and extreme jaundice.
  • Breathing difficulties, problems maintaining their temperature, and blood sugar levels.
  • A generalized higher risk of physiological problems including hernia.
  • Greater risk of developmental problems and global delays including gross and fine motor skills, speech and language development, social and emotional development, and visual acuity.

The information of this article has been reviewed by nursing experts of the Association of Women’s Health, Obstetric, & Neonatal Nurses (AWHONN). The content should not substitute medical advice from your personal healthcare provider. Please consult your healthcare provider for recommendations/diagnosis or treatment. For more advice from AWHONN nurses, visit Healthy Mom&Baby at health4mom.org.