First Signs of Twin Pregnancy

Could You be Pregnant with Twins?

What are the first signs of twin pregnancy? The pregnancy test came back positive, and sometime between the elation of the confirmation and the first ultrasound many expecting Moms wonder: Could I be pregnant with twins? Some women have reason to believe this may be the case (they underwent fertility treatments, or twins run in their families, for instance), and some women just have a "hunch". We've gathered together the 10 most reliable signs of being pregnant with twins to help sort through the possibilities.

1. You Have Extreme Morning Sickness
One of the first signs of being pregnant with twins is extreme morning sickness. About 50% of pregnant women experience a degree of nausea and/or vomiting during the first trimester of their pregnancy. This holds true for Moms of Multiples – but don’t feel you’re doomed! Only 15% of Moms pregnant with twins responding to one study reported a greater degree of morning sickness than moms expecting singletons. I’m not sure how they determined “degree” in the study. My own experience was 24-hour extreme nausea for a little past the first trimester. At 14 weeks, the morning sickness miraculously disappeared, and was I ever thankful!

2. You Are Tired Beyond Belief
Another one of the big signs of being pregnant with twins is being extremely – unbelievably – tired. While fatigue can be attributed to other factors such as work, stress, improper eating, and running after your other children, extreme fatigue can also be one of the first signs of being pregnant with twins. In fact, extreme fatigue is the most commonly reported complaint from moms pregnant with twins. Which is ironic, because the prenatal fatigue is nothing like the exhaustion suffered during the first few months of life with twins! Most pregnant women face some degree of sleepiness, lethargy and exhaustion during the first trimester as the body gears up and works overtime to nurture your growing baby. This is compounded as the body tries to nurture two (or more) growing babies. Often Moms don’t realize that they’re pregnant with twins until well into their first – and sometimes second – trimester, so they aren’t eating enough food or getting enough sleep for their body to do the work necessary.

3. You Are Always Hungry – well, more than usual
Growing a baby is hard work, and that’s especially true with twins. Instead of eating for two, you’re eating for three . . . and your body will let you know loud and clear when it needs more fuel. As I mentioned before, Moms usually don’t realize that they’re pregnant with twins until well into their first trimester, and as a result they aren’t eating enough for their body to do the work necessary in growing the multiple babies. This means constant hunger. My midnight and 4:00 a.m. refueling snacks started early in the second trimester, as did my cravings (I was eating two pints of strawberries, a day, before 12 weeks).

4. Your Clothes Don’t Fit
How much pregnancy weight a woman gains can vary depending on her height, body type and how much she weighed pre-pregnancy. However, along with the growing hunger comes additional weight gain. If you have an “obviously” pregnant belly at 8-10 weeks, you may be pregnant with twins. As the body grows with your twins, you’ll find that those third trimester clothes fit your belly just fine before you’re halfway through your second trimester. I was surprised (and should have realized something was up!) when I had to wear maternity clothes by eight weeks.

5. Your Hormones are Out of Control
Twin pregnancies often face a “multiplying factor” over singleton pregnancy symptoms. For many moms pregnant with twins, this is especially true with the “out of control pregnancy hormones”. As the body creates more hormones in larger quantities to meet the demands of growing babies, Mom’s mood swings may be more and more evident, making even the worse week of PMS look like a day at the park in comparison. A warning to those who work, live, and play with Moms Pregnant with Twins: Going from tears, to happy, to irrational, to hyper-speed and back again in the span of five minutes is not uncommon!

6. You Measure Large for Your Pregnant State
One of the things that will happen at every prenatal checkup is the measurement of the height of the uterine fundus (from the top of the pubic bone to the top of the uterus). This measurement indicates gestational age and development. As you can imagine, a twin pregnancy causes the mom's uterus to expand beyond the range of a single pregnancy as the babies grow. This is also why you will be purchasing your maternity clothes earlier than just about everyone else you know.

7. You Have Elevated HcG Levels
HcG is a hormone detectable in pregnant women's blood or urine about 10 days post-conception, and is often tested to determine pregnancy. HcG increases at a rapid rate, peaking about 10 weeks into the pregnancy. While the HcG level in twin pregnancy is within the normal range for singletons, having an elevated level of HcG may indicate that you’re pregnant with twins.

8. You Hear Two Heartbeats
Hearing your baby’s heartbeat for the first time is one of the most memorable experiences you’ll face as a parent. Using sound waves, a Doppler system amplifies fetal heart sounds that you can hear at your prenatal visits. Sometimes a physician or midwife can find more than one heartbeat, which indicates you’re pregnant with twins. That’s not always the case. Sometimes what you think is a second heartbeat may actually be background noise or the mother's own heartbeat, or baby being especially mobile at the moment. Sometimes the babies’ heartbeats are close to unison, and can’t be separated. In our case, the midwife spent 5 minutes when we were 9 weeks pregnant looking for a second heartbeat without finding one, and it wasn’t until we had an ultrasound at 12 weeks that we had any indication that we were having twins. Of course, no one had told me the signs of being pregnant with twins, either!

9. Abnormal AFP Test Results
AFP (Alphafetoprotein) screening (also known as ‘maternal serum screening’ or ‘triple marker screen’) is a blood test performed on pregnant mothers during the second trimester to identify increased risks of certain birth defects. Most Moms know if they are pregnant with twins by the time this test is performed. However, a twin pregnancy can produce an usually high -- or "positive” -- result.

10. You have an Ultrasound
Old wives tales, guesses, and hunches aside, the only way to determine you are pregnant with twins is by ultrasound and hearing those words – “Yup, there’s two (or three, or four)”. An ultrasound performed 5 – 6 weeks from conception is ‘late’ enough to confirm if you are expecting multiples, and usually how many of those multiples you can expect.

There have been some cases of ultrasounds not detecting all the babies in higher-order multiples pregnancies (there are just too many noses to count, without enough room to accurately gauge who is who).

Sometimes a twin gestation that is identified very early (before 10 weeks) is later found to have only one baby. This is called a “vanishing twin” syndrome or pregnancy.

The ultrasound remains the best way to determine if you are pregnant with multiples. Prior to the use of ultrasound technologies, an estimated 50% of moms pregnant with twins found out how many babies she was expecting on the delivery table. Talk about "twin shock"!

Our Story

At 12 weeks we had our first ultrasound, and weren’t sure what our ultrasound tech meant when she said “and there’s the other one”. My husband’s response was: “other one what”?

Looking back, many signs were there – out-of-control morning sickness, extreme fatigue (at 7 weeks it was all I could do to get up and go to work every day before coming home and collapsing on the couch), unbelievable hunger pains (which was not a good compliment to the nausea), my belly filling out well what I had thought were my second-term maternity clothes at 10 weeks, and our midwife’s long search for a second heart beat - we MISSED them all. I even had a ‘hunch’ – I had told my co-worker that ‘they’ll probably find twins or something’ as I left work for our first ultrasound.

After discovering that we were having twin boys in the first minute of the ultrasound, the remaining hour was spent between disbelief (we’re having TWINS?) to elation (we’re having TWINS!) . . . and we’ve experienced both emotions just about every day since.