Fertility treatments have made multiple births more common in recent years. That means triplets are no longer a rarity.

Doctors still consider being pregnant with multiples high-risk. But there are straightforward, simple things that expectant moms can do to stay comfortable and well.

Here’s how to increase your chances for a healthy triplet pregnancy.

Pick Your Team

For starters, pick a good doctor and medical team. They’ll become your new best friends for the next few months.

Women pregnant with triplets should expect to see their doctor every two weeks, says Dr. Dimitry Zilberman, director of Georgetown University Hospital’s Prenatal Diagnostic Ultrasound Center.

This will continue until your fetuses reach 24 weeks. After that, it’s a doctor visit once a week to make sure everything’s OK until the birth.

Eating for Four?

Doctors may prescribe supersized prenatal vitamins, extra folic acid, or iron pills to make sure moms-to-be are getting enough nutrients. The amount of extra calories you’ll need depends on how active you are. Moms of multiples may need up to 600 extra calories a day to gain the appropriate amount of weight. But your doctor might recommend a lot less, depending on your circumstances.

That was the case for Rupal Shah when she was pregnant with triplets five years ago. She had acid reflux that left her unable to eat much. Her doctors told her to eat whatever she could tolerate and leave it at that.

She gained 20 pounds during the pregnancy. Her babies were born healthy at 32 weeks.

Symptoms

In many respects, moms of triplets will have more intense symptoms during pregnancy. They’re more likely to feel exhausted and sense the growth within their bodies sooner.

Maria Damjan, a mother of 2-year-old triplets and a 4-year-old girl, says she felt her uterus expanding the day she found out about her triplet pregnancy. She remembers needing maternity clothes at week eight. That was about three months earlier than she needed them with her first child.

Many women also retain water, particularly in their ankles.

“I was literally, waist down, a big bowl,” Shah says. She remembers the swelling being so painful that she would not let anyone touch her. Showers gave her temporary relief.

Water retention is normal. But it can also be a sign of preeclampsia, a life-threatening condition. That’s one of the reasons why doctors monitor multiple pregnancies so carefully.

Exercise

Zilberman says women who are carrying triplets can go about their regular daily routines, as long as they’re comfortable.

Exercise should be fine, but get your doctor’s approval first. Some women choose to wear maternity belts for extra support. You may need to take frequent breaks from activity.

“Listen to your body,” Zilberman says. “If you are short of breath or the movement is very difficult, go from running to biking or walking.”

One of his patients, Laurena Liu, stopped running around 18 weeks into her pregnancy. But she recalls taking a spin class the day she went to the hospital. She recommends women who are pregnant with triplets stay active for as long as they can.

“It helps to make the entire pregnancy comfortable and recovery faster,” she says. “That said, don’t overdo it. I was so bummed that I could no longer run, but I had to think about what’s best for the babies, not just myself.”

Bed Rest

Zilberman doesn’t recommend bed rest for the majority of his patients. But he admits that it’s a controversial topic among high-risk pregnancy doctors.

Damjan’s doctor ordered her to go on bed rest at 20 weeks out of an abundance of caution. Damjan, who describes herself as a health nut, says she was used to exercising regularly. But she was 47 years old and had suffered two miscarriages before. She didn’t want to take any chances.

She spent the next 15.5 weeks on bed rest, and the final three weeks at the hospital. Two of her babies went home from the hospital with her. The third one stayed in the NICU for just a few days.

Risk Factors

If you are considering undergoing IVF or another fertility treatment, talk to your doctor about the risks of delivering multiples before you get pregnant. About 20 percent of triplet pregnancies result in the delivery of one child with a major long-term handicap. Talk to your doctor about how you can stay healthy throughout pregnancy and delivery.

The Takeaway

Any pregnancy comes with its share of jitters. Considering the heightened risks, it’s no surprise that moms of multiples might feel especially anxious.

Two doctors recommended that Damjan reduce her pregnancy to one fetus, something she did not want to consider. Then she found a specialist. With careful monitoring, he told her that he believed she could carry three babies safely. His team became her champions, she says. She drew strength from their confidence.

Shah remembers getting aggravated during her pregnancy because of the physical discomfort. She did breathing exercises and listened to Indian hymns to relax.

“The best advice I ever got was to keep calm, relax, and enjoy the moment,” she says. “There’s a light at the end of the tunnel. It’s so worth it the minute you deliver and you see your children.”