Close pregnancies can come with health risks like gestational diabetes and low birth weight for the baby.It’s recommended to wait at least 18 months between pregnancies to allow the body to recover fully.Ensuring a nutrient-rich diet and getting prenatal care early can make back-to-back pregnancies healthier.
Maybe you always intended to have kids close in age. Or, perhaps your family planning went a little sideways. Whether getting another positive pregnancy test soon after childbirth fills you with elation or trepidation, it’s important to understand how back-to-back pregnancies can affect your life.
Some 27% of pregnancies in the US are conceived within 18 months of a previous birth. Known among medical professionals as “short birth spacing,” giving birth in close succession can have positives—kinship among siblings, for one—but may also come with health risks.
Here is what you should know about back-to-back pregnancies, with tips for making the busy days of early parenthood and new pregnancy as healthy for you and your growing family as can be.
Risks of Back-to-Back Pregnancies
The American College of Obstetricians and Gynecologists (ACOG) recommends avoiding pregnancy intervals shorter than six months and ideally waiting at least 18 months before getting pregnant again. That’s because close pregnancy intervals, especially of 12 months or less, come with increased health risks for both the person giving birth and their baby.
These risks can include:
Gestational diabetes
Infant death
Low birth weight
Placental abruption
Precipitous labor (birth within three hours of contractions starting)
Preterm birth
Uterine rupture (following a Cesarean birth)
“The pregnant person’s body needs a chance to recover from the pregnancy itself, normalize weight, optimize nutrition, and potentially resolve pregnancy-related medical conditions,” says Erin Stevens, MD, an OB-GYN formerly with Clinic Sofia in Edina and Maple Grove, Pennsylvania.
The overall healing is particularly important after a C-section. “Births that occur 18 months or less apart have a higher risk of uterine rupture, an emergency situation in which the scar on the uterus opens prior to delivery,” adds Dr. Stevens.
After Pregnancy Loss or Fertility Treatment
Medical advice about family planning may be different if you have a history of miscarriages or fertility issues. It’s important to talk to a health care provider about the best birth spacing for you if you are dealing with pregnancy loss or are receiving reproductive assistance.
How To Manage Back-to-Back Pregnancies
Of course, back-to-back pregnancies can be a blessing for many families. That may be true if you’ve had trouble conceiving or maintaining a pregnancy in the past. And plenty of people are grateful for the closeness they feel with an “Irish Twin” born shortly before or after them.
If you’re expecting again within a year of delivering a baby, here are some tips for a safe and healthy pregnancy as well as a smooth transition to an extra-busy period of parenting life.
Get prenatal care as soon as possible
It’s easy to miss the signs of a back-to-back pregnancy since common postpartum experiences may mask early pregnancy symptoms. For example:
Your periods may not have returned (you will ovulate before your first postpartum period).
You’re fatigued from sleep deprivation.
Your breasts may be swollen and tender thanks to lactation.
If you have been having penis-in-vagina sex or engaging in sexual activities that introduce semen in or around the vagina, and suspect you could be pregnant, be sure to take a pregnancy test and make an appointment with your health care provider as soon as possible. Depending on how soon it is after you gave birth, and whether you had a C-section or not, they may want to monitor you more closely this time around.
Decide what to do about breastfeeding
What if you are still breastfeeding one baby when you discover their sibling is on the way? Some parents may choose to discontinue breastfeeding, especially if the baby has already started solid foods. This shouldn’t come with any shame. “It can be difficult to continue breastfeeding due to pregnancy symptoms like breast tenderness, fatigue, and nausea,” says Dr. Stevens.
But what if you’re feeling good, and aren’t ready to stop nursing? Science suggests that in most instances, it’s perfectly healthy to continue breastfeeding while pregnant. Here are a couple of considerations to keep in mind:
Check-in with a health care provider first: People with high-risk pregnancies should talk to a medical professional if choosing to breastfeed while pregnant, as there is some evidence that nipple stimulation is associated with early labor.
Consider upping your calorie intake: During pregnancy, you need 300 to 400 extra calories, and while lactating, you need an extra 500 calories. Be sure to get that extra energy through a vitamin- and protein-rich diet.
Keep tabs on your milk supply: Dr. Stevens says you may notice a drop in your milk supply due to hormonal changes expected in pregnancy.
Get nutrients through nutritious food
A short interval between pregnancies means your body may be at a nutritional disadvantage, so you must be vigilant about eating a nutrient-dense diet with extra calories.
“Certain nutrients such as calcium and iron must be replenished after delivery, and that takes about six months,” says John Botti, MD, professor of obstetrics and gynecology and director of maternal-fetal medicine at Pennsylvania State University’s Hershey Medical Center.
The ACOG recommends the following guidelines for getting enough key nutrients during pregnancy:
1,000 milligrams (mg) of calcium27 mg of iron770 micrograms (mcg) of vitamin A85 mg of vitamin C600 international units (IU) of vitamin D600 mcg of folic acid
Taking a high-quality prenatal vitamin can help you meet these recommendations.
What About Supplements?
Be cautious if you’re tempted to take a supplement to help with energy or sleep during this demanding period. Checking in with a medical professional before you take supplements is important any time, but especially during pregnancy. Nutritional supplements aren’t regulated by the Food and Drug Administration, and “natural” doesn’t always mean “neutral.” Too much of certain vitamins and supplements can put you or your baby at risk for health problems.
Prioritize rest
With parenting demands competing with pregnancy fatigue, you must carve out adequate rest time. “A close second pregnancy wreaks havoc on your body—but taking breaks will help you to cope,” says Moss. Some tips:
Arrange for help: If possible, arrange child care or household help throughout your pregnancy. Also, don’t hesitate to ask your partner, family, and friends for assistance.
Try sleeping whenever your baby does: It may be easier said than done, but scheduling your own nap times to align with your baby’s nap schedule may make you more likely to give yourself license to rest.
Lower your standards a bit: This is no time to try to live up to the unrealistic home-keeping standards you might see on social media. Consider making a list of essential daily or weekly tasks and not going above and beyond it.
Continue exercising
According to the ACOG, exercise is almost always recommended during pregnancy, as long as you are healthy and your pregnancy isn’t high-risk. Just be sure to talk to a health care provider about your exercise plan, especially if your last pregnancy was complicated or you had birth complications.
“Exercise is great for the pregnant person’s health and reduces the risk of some medical conditions in pregnancy. There’s also good evidence it reduces the duration of labor,” says Dr. Stevens.
Whether you choose prenatal yoga, walking, swimming, or some other form of gentle exercise, stay hydrated and don’t set overly demanding goals. Importantly, focus on the health benefits and not weight management. “If you didn’t lose weight between pregnancies, don’t try to work it off now,” says Dr. Botti.
Stay up-to-date on vaccines
It’s crucial to make sure you’re up-to-date on vaccines. The CDC recommends the following vaccines during pregnancy:
Whooping cough (Pertussis)FluCOVID-19Respiratory syncytial virus (RSV)
Make sure your baby is on schedule for their vaccines as well.
How To Avoid Back-to-Back Pregnancies
If you don’t want to get pregnant again soon after giving birth, be sure to use birth control whenever you start having sex again. “We generally recommend waiting six weeks before resuming sexual activity after birth. Whether the birth was vaginal or C-section, healing is required!” says Dr. Stevens.
The ACOG recommends thinking about postpartum birth control before you give birth so you can plan accordingly. Option that are safe to use postpartum include:
Intrauterine device (IUD): An IUD can be inserted immediately after vaginal birth or C-section or at your first postpartum visit.Hormonal birth control pills: During the postpartum stage, there is a higher risk of developing blood clots on combined hormonal pills, plus those that include estrogen may interfere with milk production. Progestin-only pills (aka the “mini pill”) don’t carry the same risks, but it’s important to take them at the same time each day.Birth control injection (Depo-Provera): You can get your first shot immediately after birth, and it lasts for three months.Condoms and spermicide: You can use condoms (and spermicide, if desired) as soon as you’ve been cleared for sexual activity.Diaphragm or cervical cap: Diaphragms and cervical caps may be used as early as six weeks after birth, but you should be refitted since your size may have changed.
In addition, breastfeeding may delay the return of your menstrual cycle due to high levels of the hormone prolactin, which naturally suppresses ovulation. But remember, getting pregnant while breastfeeding before your first postpartum period is still possible because you ovulate before you bleed.
