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Twin Pregnancy Signs and Symptoms

Feb 14, 2022 | 2 Minutes Read

One of the first questions a newly pregnant mother often asks is, “Am I having twins?” And until it is confirmed that only one embryo is present, there is always the potential for multiple babies to have been conceived.

The most accurate way to confirm twin pregnancy is by ultrasound, by as early as six to seven weeks. Some women will experience twin pregnancy symptoms shortly after conception. A very high, early human chorionic gonadotropin hormone (hCG) reading can raise suspicion there may be a twin pregnancy.

For women who have a family history of twins, who have previously conceived with twins or had fertility assistance, the likelihood of having twins is higher. Some types of fertility assisted conception increase the likelihood of having a multiple birth. This is generally discussed early on as a risk factor during a pre-conception assessment and fertility treatment.

Some women view the thought of having twins as being an absolute joy, others less favorably. Your own perception will be influenced by personal experiences, history and support systems.

For women who have been informed of the risk, or who have a history of twins in their biological family, their own twin pregnancy confirmed may not be such a surprise.

Denial, shock, feeling numb, feeling excited and even angry are common emotions in the early days of having a twin pregnancy diagnosis.

What’s so different about a twin pregnancy?

Twin pregnancy symptoms are not so different to normal pregnancy symptoms, but thy can be more exaggerated, especially in the first trimester. Twin pregnancy symptoms tend to be felt more clearly and earlier.

Though every woman is unique and her pregnancy individual, there are some standard twin pregnancy symptoms. Many are due to the elevated levels of hCG (human chorionic gonadotropin) hormone, also known as the pregnancy hormone. This is responsible for sustaining the embryo and maximizing its chances of survival.

Pregnancy hormone levels vary between women, and each person’s unique response to pregnancy. Levels of hCG tend to peak at around weeks 10 to 12 or pregnancy, before they level off or decrease

When is twin pregnancy more likely?

Here are some factors that will make a twin pregnancy more likely:
  • Women over 30 years of age.
  • Women who are perimenopausal.
  • Taller than average women. The odds are higher for having a twin pregnancy in tall women than women of average or shorter height.
  • Women who are overweight with a BMI (Body Mass Index) of 25 or more.
  • Women with a history of having already had twins or, where there are twins in their biological family.
  • Women who have had fertility assistance.
  • Women of African-American descent.
  • Women who have been pregnant before.

What are symptoms of twin pregnancy?

  • Some women will “just know” they are pregnant with twins. This may be before they have even had confirmation that they’re pregnant.
  • Feeling very nauseous early in the pregnancy. This is sometimes so extreme that the mother finds it difficult to tolerate anything but the blandest, easiest to digest foods.
  • Extreme intolerance to foods, smells, textures and appearance of some foods. Meat, seafood, coffee and tea are often the first triggering foods.
  • The uterus is “large for dates,” reflecting the fact that two embryos, rather than one is present.
  • Extreme breast tenderness, to the point where it may be too uncomfortable to wear a bra.
  • Needing to urinate much more frequently. Although urinary urgency is a common early pregnancy symptom, it’s particularly noticeable during early twin pregnancy.
  • Exhaustion and a feeling of being unable to get through each day. This is a common pregnancy symptom but it is worse during a twin pregnancy.
  • Higher levels of hCG, which may be reflected in a very early pregnancy urine test. Even before a missed period, the level can be so high that there is an immediate, strong and clear positive confirmation on the pregnancy testing stick. For women who have undergone fertility assistance, blood tests may reflect a very high concentration of hCG early after conception.
  • Some women will experience more uterine cramping not associated with any blood loss. This can be a symptom of round ligament pain and is due to the uterus expanding fairly quickly.
  • Moodiness, being prone to tears and feeling emotionally unstable are common pregnancy symptoms, but when pregnant with twins, these symptoms tend to be more extreme.
  • Movements felt early on in the pregnancy. Women who are pregnant with twins say that they are conscious of feeling movements, known as quickening, earlier than the standard 15 to 16 weeks.

How is a twin pregnancy confirmed?

There are several ways to confirm a twin pregnancy:
  • By ultrasound, where two embryos are clearly seen on the screen.
  • By hearing two separate heartbeats with a Doppler.
  • In the absence of prenatal care, it is still possible that twins may not be detected until they are born.
In the early weeks of a twin pregnancy, it’s unlikely your maternity care provider will recommend you do anything special. But as your pregnancy advances, you may need more regular prenatal appointments and scans to monitor your own as well as your babies’ health.

Complications of a twin pregnancy

Unfortunately, the overall risks of pregnancy are increased during a twin pregnancy. But many women have a straightforward pregnancy without complications. A few common complications include:
  • Premature birth, before 37 weeks of gestation.
  • Smaller babies with lower birth weight. This occurs simply because there have been two growing in the same space.
  • Twin-to-twin transfusion.
  • One baby who is smaller than the other. It is common during twin pregnancy for one twin to receive more nutrition and take up more space than the other one.
  • Preeclampsia. It’s important for all pregnant women to have their blood pressure monitored. Fluid retention and protein in urine are other signs of preeclampsia.
  • Gestational diabetes.

Things to remember

  • It’s essential to have regular prenatal care with a qualified health care practitioner.
  • It may be worthwhile to see an accredited practicing dietician to receive evidence-based diet information.
  • Allow yourself plenty of opportunity to rest. Growing twins towards maturity takes a lot of energy. You may need to consider your work and or leave arrangements and arrange regular home support and childcare for older children.
  • You may need to have more regular ultrasounds than if you were carrying one baby.
  • Plan for an earlier than expected delivery. Twins have a habit of coming early and it pays to be well organized.

Frequently asked questions about twin pregnancy

Will my twins be born premature?

Twins are more likely to be born prematurely. A premature baby is born before 37 completed weeks of pregnancy. Women with a twin pregnancy are generally advised to have more frequent antenatal monitoring.

How would I know if my twins are identical?

The only certain way to tell if twins are identical is to check their DNA. Identical twins do not necessarily look the same. There are all sorts of factors influencing a baby’s appearance even though they may share the same genetic influences as their identical twin.

Do I need to eat twice as much food in my twin pregnancy?

No. There’s lots of good research proving that a mother’s pre-pregnancy weight is a factor in how much weight she should gain during pregnancy. Excess weight can increase the risk of pregnancy complications.

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.