Twin Pregnancy Signs & Symptoms

Twin Pregnancy Signs and Symptoms

Medically Reviewed By
Dr. Shruti Kainth (Gynecologist/Obstetrician)
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Many women who are pregnant suspect that they might be carrying more than one baby, but there are some women who get surprised when they come to know that they are expecting twins. If you are pregnant and you suspect that you are carrying twins, you will get to know that through an ultrasound scan, when you go for your prenatal appointment. However, there are several signs and symptoms of twin pregnancy that could help you figure out whether it is a singleton pregnancy or multiple pregnancies. If you want to know whether you are carrying twins or not, read on to know the early signs of twin pregnancy. But do remember that the signs of twin pregnancy often overlap with the signs of a singleton pregnancy, so checking with a doctor is a must.

Video: Signs You’re Having Twins

How Soon You Can Know That You’re Pregnant With Twins?

Double the trouble, double the joy! If you’re hoping for twins, there are some signs and symptoms you can look out for. While an ultrasound is the most reliable way to confirm a twin pregnancy, some tell-tale signs include an elevated level of the hormone human chorionic gonadotropin (hCG), extreme fatigue, and morning sickness that hits harder than a freight train. Additionally, a mother carrying twins may experience more intense symptoms than those carrying a single baby, such as severe nausea, back pain, and increased appetite. So, if you’re feeling like you’re dealing with double the symptoms, it may be time to get excited about the possibility of twins!

Pregnant With Twins

As you know there are identical twins which look exactly the same and are always of the same sex and there are fraternal twins who do not exactly resemble each other and could be a boy and a girl. But what are the chances of conceiving twins and what factors determine this?

The chance of conceiving twins depends on the nationality, race, and age of a woman and whether or not she had had infertility treatment. Some other factors include the use of oral contraceptives, heredity, and nutritional factors.

Fraternal or dizygotic twins (the more commonly seen types) result from the fertilisation of two separate eggs. The less common types—identical or monozygotic twins—arise from a single fertilized egg that divides into two. A zygote normally grows into an amnion that forms the amniotic membrane or the water bag and the chorion that forms the placenta and the embryo that grow into a foetus. Depending on when monozygotic divides, there are different types of monozygotic twins:

  • If zygotes divide within the first 72 hours after fertilisation, two embryos, two amnions, and two chorions develop, and a dichorionic diamniotic twin pregnancy happens. Two distinct placentas or a single fused placenta may develop.
  • If division occurs between the fourth and eighth day, it results in a monochorionic twin pregnancy.
  • After 8 days of fertilisation, the chorion and the amnion have already differentiated, and division results in two embryos within a common amnionic sac. This is termed as a monoamniotic monochorionic twin pregnancy.

Early Signs and Symptoms of a Twin Pregnancy

Image of twins inside a mother's womb

The symptoms of a twin pregnancy will vary from a woman to woman, but most pregnant women have similar pregnancy symptoms from a very early stage. Some of the symptoms of twin pregnancy, which may also be similar to that of a singleton pregnancy are mentioned below.

1. Higher Levels of hCG

Blood and urine levels of β-hCG are generally high in case of a twin pregnancy, which is one of the early signs of twin pregnancy. hCG is the hormone which is responsible for the implantation and development of the zygote and is understandably higher when twins are conceived. If you have higher levels of hCG in the first 2 weeks, chances are that you might be expecting twins. Twin pregnancy, however, will be confirmed by a transvaginal ultrasound scan by the 8th week of pregnancy.

2. Extreme Morning Sickness

Many women experience exaggerated symptoms of pregnancy when they are pregnant with twins – experiencing extreme morning sickness is one such symptom. It is also called hyperemesis gravidarum, which begins in the first trimester of pregnancy and is associated with higher serum β-hCG levels. Women with multifetal gestation often have nausea and vomiting in excess as compared to women who have a singleton pregnancy. The morning sickness may also last for long in case of a twin pregnancy. However, the exaggerated symptoms may fade at the beginning of the second trimester.

3. Intuition

Women carrying twins may be initially totally asymptomatic or may have normal signs and symptoms of pregnancy including breast tenderness, fatigue, nausea, vomiting and cramping. It is, however, possible that these symptoms will be exaggerated. But to feel what is exaggerated you need to first feel what is normal. So such intuition-based feelings are more common in a mother who has experienced singleton pregnancy earlier.

4. Extreme Fatigue

Carrying twins puts extra stress on your body, causing extreme fatigue in the early stages of pregnancy. If you’re experiencing extreme exhaustion that you can’t explain, it might be worth checking with your healthcare provider.

5. Increased Uterine Size

Women carrying twins often have a larger uterus early on in their pregnancy. This may lead to an increased feeling of pressure or fullness in the abdomen.

6. Fetal Movement

Women carrying twins may feel fetal movements earlier and more frequently than those carrying singletons. This is due to the fact that twins have less room to move around in the uterus, so their movements are more noticeable.

Some Other Symptoms of a Twin Pregnancy

The symptoms of a twin pregnancy are not very different from the symptoms of a singleton pregnancy, the only difference is that they are more pronounced and occur in extreme. Read on to know some other common symptoms of twin pregnancy.

1. Excess Weight Gain – Weight gain in pregnancy is common, but in the case of multiple pregnancies, women tend to gain more weight. The approximate weight gained is 9 kg. However, the amount of weight a woman gains will also depend on her height, body type, and the amount of weight gained in singleton pregnancy.

2. Uterus Larger Than Date – Twin gestation may be suspected if the abdominal size is greater than expected during the time of menstrual cycles. The uterus and its non-foetal contents may achieve a volume of 10 L or more and the fundal height might be 5 cm higher than expected for singletons of the same foetal age.

3. High Blood Pressure – Women carrying twins may also have high blood pressure. In the initial stages of twin pregnancy, the diastolic blood pressure is generally low but it increases to a greater degree (2.5 times) at term. Also, there is an increased incidence of pregnancy-induced hypertension (PIH) and its related complications.

4. High AFP (Alpha-fetoprotein) Test Result – Alpha-fetoprotein is a blood test performed during the second trimester of pregnancy. It is also known as maternal serum alpha-fetoprotein (MSAFP) or multiple marker screening test, and is conducted to identify birth defects in children. In case of a twin pregnancy, the result of the test could be positive or unusually high. And the doctor may recommend an ultrasound scan for further tests.

5. Extreme Fatigue – A large uterus, excess weight gain, and extra nutrition and energy required to sustain a twin pregnancy may lead to more fatigue.

6. Early Foetal Movement – Many women experience foetal movements from quite early on in their pregnancies. And sometimes, these movements are frequent too.

7. Breathlessness – Women who expect monozygotic twins, the excessive amounts of amnionic fluid may rapidly accumulate in their bodies and the larger uterus occupy more space in the abdomen. The maternal abdominal organs and lungs may get compressed and displaced by the expanding uterus and lead to breathlessness. While this is a common symptom of pregnancy in general, a woman pregnant with twins may be more prone to breathlessness.

8. Digestion Issues – These are common with singleton pregnancies too, and may add to your discomfort. In a twin pregnancy, as the uterus is larger, a woman may experience digestion problem even more due to the pressure on the excess pressure on the digestive system.

9. Insomnia – Multiple factors internal and external can deprive you of a good night’s sleep. The discomfort, the improper position, pain, increased breathlessness on lying down, and various psycho-social factors are responsible for poor sleep.

10. Extreme Breast Tenderness – It is an early symptom seen commonly from week 4 – week 7. It may last longer. In case of a twin pregnancy, a woman may also have increased pigmentation of the areola, around the nipple.

11. Frequent Urination – During early pregnancy, increased blood flow to the kidney tend to increase the urine output. In the later stages of pregnancy, there is an increase in the pressure over the bladder by the larger uterus. This impairs the complete filling of the bladder and hence the increase in urination.

12. Cramping – As the embryo implants on the inner lining, there will be some cramping as during menses. However, in the case of twin pregnancy, with two embryos implanting, the discomfort will be slightly more.

13. Fast Heartbeat – Increase in the heartbeat is secondary to changes in the blood pressure and blood volume. It is maximum in the last trimester.

How to Confirm Your Twin Pregnancy?

Two soothers and ultrasound scans

Here’s how a twin pregnancy can be confirmed:

1. Clinical Evaluation

Careful examination with a foetal stethoscope can identify the heartbeats of the twins between 18 and 20 weeks of pregnancy. Palpating (feeling by pressing gently over the abdomen) two foetal heads can also help detect a twin pregnancy.

2. Ultrasound Scan

An ultrasound scan is the most reliable method for diagnosis of twin pregnancy. The optimal time for diagnosis is in the first trimester or early second trimester. If two separate placentas are seen, dichorionic gestation is diagnosed. It is important to know the chorionicity as soon as possible during pregnancy because it can affect future management decisions.

3. Doppler Heartbeat Count

In the later stages of the first trimester, the foetal heartbeat may be detected with a Doppler ultrasonography. It is then possible to identify two foetal heartbeats if their rates are clearly distinct from each other and from that of the mother.

4. Magnetic Resonance Imaging

In rare circumstances when the diagnosis is not possible through an ultrasound scan, an MRI may aid the diagnosis. However, an MRI uses a magnetic field, and pulses of radiofrequency and there is some apprehension that it may not be advisable in pregnancy. An MRI can be performed in the first trimester of pregnancy, but it is advisable to consult a doctor about any possible side effects before opting for it.

Things To Keep In Mind If You Are Having Twins

Having twins is an exciting and unique experience, but it can also come with its own set of challenges. From the moment you find out you are expecting twins, there are some important things to keep in mind to ensure a healthy and successful pregnancy. Here are five key points to consider when having twins.

1. Monitoring and managing your weight gain is crucial – With twins, it is common to gain more weight than with a singleton pregnancy, so it’s essential to work closely with your doctor to maintain a healthy weight and avoid any potential complications.

2. Prenatal care is a must – Twin pregnancies require more monitoring and care than singleton pregnancies, so make sure you have a healthcare provider who is experienced in managing twin pregnancies and can closely monitor you and your babies throughout your pregnancy.

3. Prepare for an earlier delivery – Twin pregnancies are more likely to result in a preterm delivery, so it’s essential to be prepared for an earlier arrival of your little ones. Make sure you have a plan in place for premature birth and talk to your healthcare provider about any potential complications.

4. Get support from family and friends – Having twins can be overwhelming, and you may need more help than you would with a singleton pregnancy. Don’t be afraid to ask for help from family and friends, and consider joining a support group for parents of multiples.

5. Be prepared for the unique challenges of raising twins – From sleep deprivation to managing double feedings, raising twins can be challenging. It’s essential to have a plan in place for how you will manage the demands of caring for two infants and to be prepared for the unique joys and challenges that come with having twins.

How You Can Deal With Twin Pregnancy Stress?

Growing and carrying two babies at the same time can be a wonderful experience, but it can also be stressful and overwhelming. Twin pregnancy stress can arise due to various reasons such as physical discomfort, financial concerns, anxiety over the babies’ health, and more. To help you cope with this stress, here are some useful tips to keep in mind.

  • Stay active and exercise regularly, but don’t overdo it.
  • Prioritize self-care activities such as taking a warm bath, getting a massage, or practicing meditation.
  • Build a support system with friends, family, or a support group for parents of multiple.
  • Communicate your feelings and concerns with your partner, healthcare provider, or therapist.
  • Prepare for the arrival of your babies by creating a birth plan, setting up the nursery, and organizing the household.


1. Is It Normal To Bleed During the 1st Week Of Twins Pregnancy?

While some women may experience light spotting during the early stages of pregnancy, bleeding can be a cause for concern, especially if you’re carrying twins. Bleeding during the first week of a twin pregnancy can occur due to a variety of reasons such as implantation bleeding, subchorionic hemorrhage, or infection. It’s important to consult your doctor immediately if you experience any vaginal bleeding or spotting, cramping, or abdominal pain. Keep in mind that not all women experience the same signs of twins or signs that they’re having twins, so it’s best to trust your instincts and seek medical attention if you have any concerns.

2. Can You Get A False Negative Pregnancy Test With Twins?

It’s a common misconception that you might get a false negative pregnancy test if you’re pregnant with twins. However, the truth is that pregnancy tests work by detecting the presence of the hormone human chorionic gonadotropin (hCG) in your urine or blood, and this hormone level doubles every 48 to 72 hours in the early weeks of pregnancy. So, if you are pregnant with twins, your hCG levels will be higher, and you are more likely to get a positive pregnancy test result sooner. However, if you take a pregnancy test too early, you might get a false negative result, regardless of whether you’re having twins or not. If you’re experiencing signs you’re having twins , such as severe morning sickness or a larger-than-normal belly, you should talk to your healthcare provider to confirm your pregnancy status and discuss any concerns.

3. What Activities You Can Do And Avoid During Twin Pregnancy?

Congratulations, you’re having twins! Now that you know you’re carrying two little bundles of joy, you might be wondering what activities are safe for you to do and which ones to avoid during your twin pregnancy. Firstly, it’s important to note that every pregnancy is unique, so it’s best to consult with your doctor about any specific concerns you have. However, there are some general guidelines to keep in mind. Activities that are generally safe to do during a twin pregnancy include light exercise, prenatal yoga, and swimming. It’s important to avoid high-impact activities or anything that puts you at risk for falls or injury. As always, listen to your body and if something doesn’t feel right, don’t push yourself. With these tips in mind, you can enjoy a safe and healthy twin pregnancy!

4. At What Stages Do Twins Forms And What Will Be The Position Of Twins In Womb?

If you’re wondering at what stage twins form, the answer is during the early stages of pregnancy. Identical twins are formed when a single fertilized egg splits into two embryos, and fraternal twins occur when two eggs are fertilized by separate sperm. Signs of twins can include a higher level of hCG (pregnancy hormone) in your blood, severe morning sickness, and a larger-than-usual uterus size. As for the position of twins in the womb, this can vary. Twins can be positioned side by side or one on top of the other. In some cases, one twin may be in a breech position (feet first) while the other is in a head-down position. Your doctor will monitor the position of your twins throughout your pregnancy to ensure a safe delivery.

If you suspect that you are carrying twins, the above symptoms will help you find out whether you are right or wrong. But we suggest that you check with a doctor to confirm whether or not you will be welcoming two bundles of joy in your family!


1. American Pregnancy Association, Multiple Pregnancy: Twins or More,, 2022

2. Mayo Clinic, Multiple Pregnancy,, 2021

3. Mayo Clinic, Twin Pregnancy: What You Need to Know,, 2022

4. National Organization of Mothers of Twins Clubs, Inc., Preparing for Twins: A Checklist for Parents Expecting Twins,, 2022

5. Twins and Multiple Births Association, Multiple Pregnancy,, 2022

6. National Institutes of Health, What are the signs and symptoms of multiple pregnancy?,, 2021

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