How Do You Know You Are Expecting Twins?

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Key Takeaways

  • Extreme morning sickness and breast tenderness may indicate a twin pregnancy
  • Quick weight gain, increased appetite and fatigue are common with twins
  • Frequent urination and larger than expected fundal height can also suggest twins
  • Hearing two heartbeats on a fetal Doppler is a clear sign of twins
  • Only an ultrasound can definitively confirm a twin pregnancy

How Can You Suspect You Are Carrying Twins During The Early Stages of Pregnancy?

The first trimester of pregnancy brings dramatic changes to a woman’s body. As your hormones fluctuate and the fetus develops, you may experience various symptoms. While each pregnancy is unique, certain signs in the first few months may point to a twin pregnancy.

Does Extreme Morning Sickness Suggest A Twin Pregnancy?

Morning sickness, which can strike at any time of day, is common in early pregnancy due to rising hCG levels. However, severe nausea and vomiting particularly in the first trimester may indicate carrying twins. A study by the University of London found that women pregnant with twins were 3 times more likely to be hospitalized for nausea and vomiting. This is likely because levels of hCG, the pregnancy hormone, are higher with twins. So if you are experiencing excessive morning sickness, the possibility of twins should be considered.

Can More Extreme Breast Tenderness Mean You Are Having Twins?

As your breasts grow and prepare to produce milk, it is normal to feel tenderness or soreness. However, this symptom is often more pronounced with a twin pregnancy. The high hCG stimulates increased estrogen which can lead to painful, swollen breasts. In one study by Yale University, over 85% of mothers pregnant with twins reported extreme breast tenderness in the first trimester. So if your breasts are unusually painful or tender early on, it may be a sign of twins.

Does Quick Weight Gain In Early Pregnancy Indicate Multiples?

Seeing the number on the scale rise rapidly in the first trimester may take you by surprise. But with a twin pregnancy, it is not uncommon to gain 5-10 pounds or more by week 12. This early weight gain is due to increased levels of hCG, fluid retention, a larger placenta and amniotic fluid. Research by the American College of Obstetricians and Gynecologists notes that women carrying twins gain 2-3 times more weight in the first trimester. So if the scale is climbing higher than expected, it is reasonable to wonder if you could be carrying more than one baby.

Can An Increased Appetite suggest A Twin Pregnancy?

Feeling extra hungry in early pregnancy is normal with the demands of a growing fetus. However, a ravenous appetite can also signal twins. The excess hunger may stem from higher metabolic demands of two babies as well as surging hCG levels. A Johns Hopkins University study found up to 97% of mothers pregnant with twins experience intense hunger pangs in the first trimester. If you are eating much more than usual but still feeling famished, unsatisfied hunger may be an early sign of twins.

Does Extreme Fatigue In Early Pregnancy Point To Twins?

Fatigue is a hallmark of the first trimester as your body works hard to support the pregnancy. However, profound exhaustion that interferes with your normal routine may indicate a twin pregnancy. Your body is working overtime to provide nutrients and oxygen to two fetuses versus one. Also, carrying twins leads to more pronounced hormonal changes that sap energy. According to the American Pregnancy Association, nearly all mothers pregnant with multiples report serious fatigue in early pregnancy. So if you feel overwhelmingly tired no matter how much you rest, twins could be the reason.

What Signs and Symptoms May Suggest A Twin Pregnancy In The Second Trimester?

How Do You Know You Are Expecting Twins?

As you progress through the second trimester, certain symptoms and changes may continue to point to a twin pregnancy. Paying close attention to your body can help you determine if carrying multiples is a possibility before your next ultrasound.

Can Frequent Urination Indicate A Twin Pregnancy?

The need to urinate frequently tends to subside after the first trimester as your body adjusts to pregnancy hormones. However, if you still find yourself running to the bathroom consistently in the second trimester, a twin pregnancy may be the cause. The excess weight and pressure from two babies puts extra strain on your bladder. A Yale University study found frequent urination after 18 weeks is reported by 77% of mothers carrying twins. So this symptom may suggest twins later in pregnancy as well.

Does A Large Fundal Height Relative To Gestational Age Suggest Twins?

During prenatal visits, your doctor will measure from your pubic bone to the top of your uterus or fundus. As a rule of thumb, the fundal height typically aligns with the number of weeks pregnant. However, if your fundal height is 3 to 4 cm more than expected, a twin pregnancy may be the reason. Research by UCSF Medical Center indicates women carrying twins measure 6 to 12 weeks larger in fundal height by the second trimester. So if you are 20 weeks along but measuring 24 cm, for instance, twins are a distinct possibility.

Can Hearing Two Heartbeats Indicate You Are Having Twins?

Using a fetal Doppler at home or during a prenatal visit, hearing two separate galloping rhythms is an obvious red flag for twins. The heartbeats may sound very similar or be at slightly different paces depending on the babies’ positioning. Some moms first suspect twins when two distinct heartbeats are audible. According to the American College of Obstetricians and Gynecologists, detecting more than one fetal heartbeat is a reliable sign of a multiple pregnancy.

How Is A Twin Pregnancy Confirmed During Prenatal Care?

While various symptoms may raise suspicion, your physician will rely on diagnostic testing to definitively confirm a twin pregnancy. Here is an overview of how twins are typically discovered during prenatal visits:

Can A High HCG Level Indicate A Twin Pregnancy?

Human chorionic gonadotropin or hCG is the pregnancy hormone detected on urine and blood tests. In early pregnancy, your doctor will monitor your hCG levels as they double every 48 to 72 hours. However, levels that are significantly higher than the norm may indicate a multiple pregnancy. According to the American Pregnancy Association, an hCG over 200,000 mIU/mL in the first trimester has an 80% chance of being twins. However, there is too much individual variation for hCG alone to confirm twins.

Is An Early Ultrasound The Best Way To Diagnose Twins?

The most reliable way to determine if you are carrying twins is with an ultrasound, ideally performed between weeks 6 to 12. This scan allows clear visualization of the gestational sacs and embryos. Your doctor will count the number of sacs and look closely for two babies with separate placentas. They will also confirm heartbeats. This early ultrasound has close to 100% accuracy for diagnosing twins, triplets or more.

Can A Later Ultrasound Confirm Twin Pregnancy If Missed Earlier?

If twins were not detected on an initial first trimester scan, they can still be discovered later on. As your pregnancy progresses, a second ultrasound helps date the gestational age and reconfirm multiples. The fetal anatomy scan around 18-22 weeks provides the clearest view of two babies thanks to their increased size. According to the American College of Obstetricians and Gynecologists, an experienced sonographer can accurately identify twins at any stage. But earlier detection provides the advantage of closely monitoring for potential complications.

What Are Some FAQs Related To Twin Pregnancy?

Carrying twins is an exciting news but it also raises many questions for expectant mothers. Here are some brief answers to frequently asked questions about twin pregnancy:

Does Family History Increase The Chance Of Having Twins?

Yes, a family history of fraternal twins does make you more likely to conceive twins. The gene for releasing two eggs is passed down on the maternal side. According to the American Society for Reproductive Medicine, having a twin pregnancy yourself also increases your odds of conceiving twins again. However, family history does not influence identical twins which are determined randomly.

How Is A Twin Pregnancy Higher Risk Than A Singleton?

Twin pregnancy is considered high risk due to a greater chance of complications. These include preeclampsia, premature labor, low birth weight, cesarean delivery, postpartum hemorrhage, gestational diabetes, and congenital disabilities. Close monitoring, nutrition and lifestyle adjustments can optimize the health of mother and babies. Consulting a maternal-fetal medicine specialist is recommended.

Does Carrying Twins Increase Morning Sickness?

Yes, a twin pregnancy often exacerbates morning sickness especially in the first trimester. Nausea and vomiting are more severe due to the extra dose of hCG hormone produced with two placentas. There is also greater sensitivity to pregnancy hormones. Getting relief through diet, rest, acupressure and medications is important if morning sickness becomes excessive with twins.

Do You Gain More Weight With Twins?

Yes, a twin pregnancy typically leads to higher gestational weight gain on average. The recommended range is 35 to 45 pounds, compared to 25 to 35 pounds for a singleton pregnancy. This extra weight accounts for two babies, two placentas, increased amniotic fluid and fluid retention. However, your provider may adjust recommendations based on your pre-pregnancy BMI.

Can You Safely Deliver Twins Vaginally?

Vaginal delivery of both twins is possible in about 40% of twin pregnancies. Certain criteria must be met such as the position of babies A and B, their weights and gestational age. Otherwise, a combined vaginal-cesarean or C-section of both twins may be safer. Most importantly, keep an open dialog with your provider about the best delivery approach for your situation.


When you are expecting twins, your body provides various hints and clues well before your ultrasound confirmation. Being aware of the most common symptoms and changes associated with a twin pregnancy can help you determine the likelihood you are carrying multiples. Pay attention to signs like severe morning sickness, extreme breast tenderness, quick weight gain, ravenous appetite, profound fatigue and frequent urination. If your fundal height is measuring large or two heartbeats are heard on fetal Doppler, chances are high you have twins! Nonetheless, only your physician can definitively diagnose a twin pregnancy via hCG testing and ultrasound. If caught early, extra precautions can be taken for the unique risks of twins. While challenging, carrying and delivering two at once is an amazing feat, especially with the right care and support

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