Growth abnormalities which include intrauterine growth restriction and weight discordance between twins are common in pregnancies complicated by multiple gestations and may be associated with poor perinatal outcomes. Knowledge of chorionicity is paramount when managing a multiple pregnancy. Monochorionic twins are at greater risk than dichorionic twins for growth issues, which may result in long-term complications including adverse neurological sequelae for the offspring. The purpose of the following article is to define normal and abnormal growth in multiples. In addition, the management of growth abnormalities in relationship to chorionicity will be discussed.