twins in pregnancy

What Are The Symptoms Of Twins In Early Pregnancy?

In the early days of pregnancy, it can be difficult to tell if you are pregnant with one or two babies. 

Many factors will complicate this determination, such as twins having different implantation sites and gestational ages. However, there are a few symptoms that may indicate you’re expecting twins! 

Suppose you have been feeling increased pelvic pressure, cramping in one side of your abdomen for longer than usual, spotting between periods and nausea lasting throughout the day. In that case, the chances are good that you may just be dealing with a normal singleton pregnancy. 

However, if these symptoms persist along with other indicators like weight gain at a rapid rate or needing to use the bathroom frequently, then it is possible that you could be carrying two babies!

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Symptoms That Show You Might Be Expecting Twins

Are There Signs That You’re Carrying Twins?  

As soon as pregnancy begins, your body begins to produce hormones and undergo physical changes. 

These changes may be the first sign of pregnancy. What’s more, some of these signs may be slightly different when you’re expecting more than one baby.

Many people who experience twin pregnancy report that they were expecting multiples, even before they knew for sure. On the other hand, for many people, the news comes as a complete surprise.

The following symptoms are commonly reported as signs that you may be pregnant with twins from the earliest weeks of pregnancy.

Tests, Checks And Appointments During Twin Pregnancy

If you’re pregnant with twins, you’ll need a higher level of care, which means more appointments and tests during your pregnancy.

You probably won’t need lots of extra blood tests, but you will need more ultrasounds.

If you have twins with separate placentas, it’s generally recommended that you have ultrasounds at 12-13 weeks, 20 weeks, and then every four weeks until your babies are born. However, you might have more frequent ultrasounds than this.

Twin pregnancy with babies sharing one placenta might be more complicated, so it’s generally recommended that you have ultrasounds about every two weeks from 12 weeks.

If you’re pregnant with twins, you’ll have more frequent antenatal appointments. This is because antenatal appointments are an excellent chance to get health and lifestyle support if you need it. 

You can also get information about pregnancy, labour, birth and early parenting.

Will Your Twins Be Born Early?

Health professionals usually aim for twins to be born at 37-38 weeks unless problems develop earlier or there’s a good reason to delay birth.

About 60% of twins are born before 37 weeks, while single babies are born at around 40 weeks.

If you know your twins will be born early, you can get ready for premature birth.

Vaginal Or Caesarean Birth

It’s good to talk with your obstetrician and midwife about your health and your babies’ health and whether vaginal or caesarean birth will be better for you and your twins.

If you’re having twins, you’re almost twice as likely to have a caesarean birth.

You can discuss the most appropriate time and ‘way’ for you to give birth to your twins with your obstetrician.

Preparing For Parenting Twins

Parenting twins can be very rewarding and very challenging at times too. Here are ways to get ready for parenting twins:

Communication with your partner is an essential part of continuing a healthy relationship. In addition, pregnancy is a great time to discuss and share your thoughts and expectations for the future. 

You might like to watch our video on relationships in pregnancy and early parenting and read about pregnancy and healthy relationships.

Look at our resources on breastfeeding. You can breastfeed your twins, and it’s suitable for you and your babies. 

You can ask for help from a lactation consultant or your midwife. You can also ask your birth hospital if there are classes specifically for expectant parents of twins.

Read about services and support. As parents of twins, you and your partner will find that life is hectic, so it’ll help to support family and friends.

Enrol with the Australian Multiple Birth Association (AMBA). The AMBA offers a range of support services and links to other services for new parents of twins. You might also like to register your twins with Twins Research Australia.

Potential Health Complications In A Twin Pregnancy

Women with twin pregnancies are more likely to have pregnancy health problems and complications like gestational diabetes, pre-eclampsia, premature labour and bleeding.

Twins who share a placenta might have extra complications. Sometimes their blood supply is shared unequally, which can cause health problems for both twins. 

Or, if the placenta itself is shared unequally, this can mean that one twin doesn’t get enough nutrients and doesn’t grow as well.

You can’t stop some of these complications from happening. But you can reduce your risk of having them – or prevent them from getting worse – by going to your antenatal appointments and telling your obstetrician, doctor or midwife if you have any physical symptoms or feel that something is wrong.

Morning Sickness 

It’s not entirely clear why some people experience morning sickness, but it can begin as early as the 4th week of pregnancy for many pregnant people, which is right around the time you miss your period.

Increases in the pregnancy hormone human chorionic gonadotropin (hGH) may contribute to nausea at any time of the day. (That’s right, morning sickness doesn’t only happen in the morning.)

Some people pregnant with multiple babies report experiencing elevated morning sickness or morning sickness that lasts longer into their pregnancy. 

It can be challenging to establish a baseline for morning sickness, as it can vary from person to person and from pregnancy to pregnancy.

Experiencing nausea and vomiting that lasts beyond the 14th week of pregnancy could indicate that you’re pregnant with multiple babies.

Unfortunately, experiencing severe or prolonged morning sickness can also be an indicator of hyperemesis gravidarum.

If you’re vomiting several times a day, experiencing nausea all day, or losing weight, it’s a good idea to speak with your OB-GYN.

You Have Exaggerated Symptoms

Pregnant women commonly experience morning sickness, food cravings, fatigue, frequent urination. 

It might not come as a surprise that the presence of two babies exacerbates these symptoms.

Some pregnant moms of multiples report they intensified nausea, fatigue, breast tenderness, food cravings, or the like. 

It’s more common in women who have experienced a previous pregnancy and thus have a basis ​for comparison. 

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You Have Characteristics That Increase The Odds

While sometimes a twin pregnancy just “happens,” there are some characteristics that increase the odds that a woman will have twins or multiples, including:

Conception while breastfeeding or on birth control pills: Hormone fluctuations may affect your odds of having twins.

Family history: Having “the twin gene” makes a woman more susceptible to having a fraternal twin birth, in which more than one egg is released at once. 

There may also be genetic associations in some identical twins, where one embryo divides.1 

Fertility treatments: As hormonal therapies such as in vitro fertilisation (IVF) become more common, the frequency of twin births increases, as well, thanks to the resulting ovarian stimulation that may release more than one egg at a time.

Higher body mass index (BMI): A BMI above 25 is associated with an increased probability of having twins.

Maternal age: Above 30, the likelihood of releasing more than one egg while ovulating increases.

However, many incidences of twins are random and not attributable to any specific cause or characteristic. Thus, for many families, their double blessing is simply a result of luck!

You Have Elevated Hcg Or Afp Levels

Human chorionic gonadotropin (hCG) is a hormone produced by the body during pregnancy. 

Home pregnancy tests detect this hormone in urine to give you a positive test result. While home pregnancy tests can’t tell you the specific hCG level in your body, blood tests can.

If you’re undergoing specific fertility treatments, you may have blood drawn to check on your hCG numbers. 

Your OB will establish a baseline, then watch to see whether the numbers double as expected. 

A 2018 study, Trusted Source, showed that those pregnant with multiples might have a higher than expected hCG count.

Doctors or midwives may perform standard screenings early in pregnancy to check hCG (human chorionic gonadotropin) levels; a hormone produced during pregnancy. If the levels are high or accelerated, it may indicate multiple pregnancies. 

An AFP (Alpha-Fetoprotein) screening occurs later in pregnancy and tests for the bias of chromosomal abnormalities or congenital disabilities. 

This type of testing may be referred to as maternal serum screening, triple screen, quad screen or Penta screen.

Based on the screening result, doctors may recommend further testing. For example, an abnormally high impact could be caused by multiple babies, such as twins.

In either case, unexpected results are cause for further investigation, which could confirm the presence of twins.

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You Feel Fetal Movement Early

One of the most exciting moments of pregnancy is feeling the baby move within your womb. 

That fluttery, swishing, quivery feeling from deep within your belly connects you to your unborn child, cementing the bond between mother and baby.

Some women describe it as butterflies or a swimming fish. Usually, women can feel this sensation, known as quickening, about midway through the pregnancy, between 16 and 25 weeks. 

Although there’s not much science to support it, some moms of twins report feeling movement earlier and more frequently in pregnancy, sometimes as early as the first trimester. 

It might even be their first clue that there are more than just two tiny hands and two tiny feet waving around in the womb. 

Women who have had a previous pregnancy generally recognise fetal movement earlier. 

After all, they have a basis of comparison and more awareness of the sensation, leading them to conclude that there’s something more. 

Large For Gestational Age Or Gaining Weight Rapidly

No doubt carrying two babies has a significant impact on a woman’s body. Not only are moms of twins likely to gain more weight, but their uterus will also stretch and expand to accommodate the extra baby.

Most doctors and midwives will monitor weight gain and fundal height (a measurement between the pubic bone and the top of the uterus) during routine appointments. 

An excess of either may point to multiple pregnancies, although there are plenty of other explanations, such as increased amniotic fluid levels. If your caregiver has reason to suspect multiples, they’ll investigate further.

Early Movement 

Since most parents don’t report feeling movement until around 18 weeks, this isn’t an early sign either. 

Your baby moves in the womb initially, but it’s unlikely you’ll feel anything until your second trimester.

Of course, having two or more babies can mean that you’ll feel movement slightly earlier than you would have with only one baby, but this is very unlikely to happen before your second trimester.

Measuring Ahead 

Measuring ahead isn’t an early sign of twins, as it’s unlikely that your provider will measure your belly until after 20 weeks of pregnancy. However, you likely have an ultrasound scheduled if you haven’t already had one at this stage.

Some people report showing earlier when pregnant with twins, but the point at which your pregnancy begins to show varies depending on the person and the pregnancy. Many people will show earlier during their second pregnancy.

You Have A Sneaking Suspicion

The old wives’ tale that double yolks are a sign of twins may ring true for some! Start noticing any potential symptoms and tapping into your early maternal instincts. 

Dreams, premonitions, intuition, hunches many moms of twins look back in hindsight and realise they encountered these serendipitous signs shortly before they found out they were pregnant with more than one baby.

How Twin Pregnancies Are Confirmed

Current medical technology makes the diagnosis of twins much more accessible than in the past century. Two ways to confirm a twin pregnancy are through ultrasound and fetal Doppler monitor.

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Increased Weight Gain 

This is another sign that may not come into play until further along in your pregnancy. During the first trimester of your pregnancy, weight gain is likely to be relatively low.

The standard recommendation is a gain of 1 to 4 pounds over the first 12 weeks. Weight gain happens more rapidly in the second trimester, regardless of whether you’re expecting a single baby or more.

If you are gaining weight faster during your first trimester, you should speak with your OB-GYN about possible causes or concerns.

The Centers for Disease Control and Prevention (CDC) notes the following weight gain guidelinesTrusted Source, which is based on pre-pregnancy body mass index (BMI), for women pregnant with twins:

  • BMI less than 18.5: 50–62 lbs.
  • BMI 18.5–24.9: 37–54 lbs.
  • BMI 25–29.9: 31–50 lbs.
  • BMI greater or equal to 30: 25–42 lbs.

However, if you’re experiencing morning sickness or other issues, you may not gain (and even lose) weight in the first trimester. So, again, if you’re concerned about your weight gain, you may want to speak with your doctor.

Two Babies Are Visible On An Ultrasound

Ultrasound uses sound waves to create an image of the womb. A transducer sends high-frequency sound waves into the body; as the sound waves bounce off organs and structures, they produce electrical signals converted into images. This peeks into the womb can clearly show two fetuses or even two embryos early in the pregnancy.

In the past, ultrasound scans could potentially miss a twin pregnancy, for example, if two embryos were close together and one source obscured the other. 

But the clarity and precision of modern imaging and more frequent use of ultrasound during pregnancy make it less likely that a twin would remain hidden. 

Second Heartbeat 

Your baby’s heartbeat may be heard as early as 8 to 10 weeks using a fetal doppler. If your OB-GYN thinks they hear a second heartbeat, they’ll likely suggest scheduling an ultrasound to get a better picture of what’s happening.

Two Distinct Heartbeats Are Heard

Several tools can be used to listen for a fetal heartbeat during pregnancy, including a stethoscope, fetoscope, or Doppler monitor. 

With careful listening, a doctor or midwife can sometimes detect multiple distinct heartbeats and might suspect twins. If so, an ultrasound scan can provide confirmation.

However, listening for heartbeats can be tricky and certainly not foolproof. It can be not easy to distinguish individual heartbeats, especially if they beat at about the same pace. And, the sound of mom’s heart can muddle the results. 

What Are The Chances Of Having Twins?  

According to the CDC, the rate of twins was 32.6 twins per 1,000 total birthsTrusted Source in 2018. 

Many different things contribute to the number of twins born each year. Factors like age, genetics, and fertility treatments can increase your likelihood of becoming pregnant with twins.


While a pregnancy with twins or more is exciting, it comes with some risks. Therefore, focusing on your health and seeking prenatal care is especially important during multiple pregnancies.

Early pregnancy symptoms can’t tell you for sure whether you’re pregnant with two or more babies, but regular prenatal appointments and testing can. 

Always discuss your concerns with your OB-GYN, and take good care of yourself — no matter how many babies you’re carrying.

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