Signs You May be Pregnant with Twins; And How to Prepare for the Journey Ahead

You’re pregnant; congratulations!

Whether your pregnancy was planned or a surprise, you are likely preparing mentally and physically for your new addition. The question of boy or girl? may run through your mind right away, but what about how many?

If you have never been pregnant before then you have no reference point to know if anything feels different to a normal pregnancy. But what is your intuition telling you? 

A nagging feeling that you have twins may be enough to get your curious enough to be reading this article. The good news is there are likely some hints your body is giving you that you may have a multiple pregnancy. 

We will discuss both the physical and mental symptoms that you may experience if you are carrying twins. As well as share some information to help you prepare for this journey.

signs you may be pregnant with twins

Likelihood of Conceiving Twins

Twin pregnancy is not common and makes up only 3% of pregnancies in the U.S. (as of 2013). This number has risen considerably over the past 30 years or so (by about 76%).

This is due to some social trends around parenthood that are linked to an increased likelihood of twin conception:

  • Maternal age: waiting until the age of 30 or later due to hormone increase
  • Family history: the number of fraternal twin pregnancies (not identical) on one or both sides of the family
  • Weight: excess fat stores extra estrogen which may release more eggs at ovulation
  • Multiple children: large families and multiple pregnancies
  • Breastfeeding: about 11.4% of twins are conceived while breastfeeding
signs of twin pregnancy

Fertility treatments can also increase the likelihood of conceiving twins. Particularly those that boost ovulation. These include treatments and drugs like:

  • Clomid
  • Femera
  • Gonadotropins
  • IVF treatments

With IVF treatments, in particular, doctors often attempt to fertilize multiple eggs and transfer several embryos at once in the hopes that at least one takes. In some cases, several take and result in a multiples pregnancy.

Fraternal Vs Identical Twins

There are two classifications for twins – fraternal and identical.

There is a common misconception that identical twins are named as such since they look alike. However, twins being identical or fraternal depends on the number of eggs they form from.

Identical (monozygotic) twins develop from one fertilized egg that splits into 2, and fraternal (dizygotic) twins come from two eggs that happened to be fertilized.

Because of this, identical twins will always be the same gender. Since boys and girls have different chromosomes and twins have the same DNA. 

Not only can the difference between identical and fraternal twins determine gender but it can also make a difference when it comes to medical risks during your pregnancy or your twins’ health later in their lives.

Identical twins can sometimes share a single placenta. This can pose a unique risk for twin-to-twin transfusion syndrome (TTTS).

This is when there is uneven blood flow between the two babies; one ends up receiving more than the other, developing high blood pressure and filling the amniotic said with urine. While the other ends up dehydrated and is often born smaller.

Without treatment (fetal surgery), this condition often ends up fatal for both babies.

In addition to fetal health risks, identical twins can often develop the same genetic diseases since they share the same DNA.

Now, this doesn’t mean that identical twins are more likely to develop a disease. Rather, it’s just that if one of the twins develops a genetic disease later in life, their twin has a higher chance of developing it as well due to their shared DNA.

There is only a 1%-2% chance of birthing twins.

Because of this, couples typically expect only one baby. 

So if you are a twin, one of you is an unplanned mistake

Pregnancy Timeline

What do the early stages of a twin pregnancy look like?

It all starts with a fertilized egg – or two, depending on what type of twins you’re pregnant with. Once the bundles of cells (called morulas) make their way down your fallopian tubes and implant in your uterus, creating both the embryos and placenta(s).

The first twelve weeks (trimester) or a twin pregnancy are very touchy; this is when embryo development is the most volatile.

In some cases, one of the twins can be miscarried without affecting the other.

For mothers who are aware they are pregnant with twins, they may not even notice the miscarriage until their next scan, when the doctor realizes that the embryo has been absorbed back into the mother’s body.

Most twins can be seen on an ultrasound scan (with separate heartbeats) by a little after 6 weeks of gestation, but most mothers don’t even know they’re pregnant by then and don’t have their first scan until near the end of the first trimester.

If you experience bleeding or have undergone fertility treatments, you may see the doctor for a scan at the first suspicion of pregnancy.

Symptoms of Twin Pregnancy

Physical Symptoms

You may be curious to know if you can tell you’re having twins before you find out for sure on the sonogram.

The signs are not be definitive, but they can strongly indicate that you may be pregnant with twins.

The first thing you may notice is that “normal” pregnancy symptoms start earlier and are much more severe with a twin pregnancy. You are likely to suffer from worsened nausea, extreme fatigue, and earlier weight gain (not to mention extra pounds later).

There is even evidence to show that extreme cases of pregnancy sickness, also called hyperemesis gravidarum (HG), are highly likely. This occurs in 14.2 per 1000 twin pregnancies compared to 3.58 per 1000 in singletons. Symptoms include severe nausea and vomiting as well as weight loss and electrolyte imbalance.

If these symptoms aren’t enough to convince you of a twin pregnancy, certain observations by your doctor may be more definitive.

The first is finding elevated levels of hCG, otherwise known as the pregnancy hormone.

High levels of hCG does not necessarily determine a twin pregnancy as hCG levels fluctuate regularly throughout pregnancy and spikes may be due to other factors, but when witnessed with other signs and symptoms, it is a possible determinant of twin pregnancy.

Another possible funding that couple signify a twin pregnancy is abnormal levels of alpha-feto protein (AFP), a substance from your baby that can mix with your blood.

This may not be an early determinant as AFP tests aren’t usually done until 15-16 weeks of pregnancy, but elevated levels could be caused by the presence of twins.

Finally, if you are measuring large for gestational age (LGA), this could be a sign of a twin pregnancy.

Your doctor checks your uterus size at each appointment by measuring and feeling your belly. Since you have two babies growing in a twin pregnancy, your uterus will grow much quicker to accommodate for the extra baby.

signs of twins

Mental Symptoms and Challenges

For first time parents, twins can be a scary word. Receiving news that you are pregnant with twins can often bring stress and worry for both your pregnancy and life after delivery.

Twins bring more financial responsibility. Two babies mean double everything – diapers and wipes, clothes, cribs, blankets, strollers, etc. Planning your budget for the extra expenses that come with twins can be stressful.

The thought of raising two children can also cause first-time parents to feel overwhelmed.

Twins often come with their own personalities and schedules, and as they get older, they may choose to express their individuality through behaviours and individual desires (hobbies, sports, décor, friends, etc.).

For pregnant mothers, the news of twins can also bring about concerns for pregnancy and delivery. Carrying two babies means there are additional health risks for both baby and mom.

It also means that any plans she may have had for delivery are no longer valid as most twin pregnancies don’t last until 40 weeks and end in a cesarean section.

carrying multiples signs

Antepartum and Post-Partum Depression

Depression can also be a common problem both during (antepartum) and after (post-partum) pregnancy, and it is believed to be worse in most cases of twins or multiples.

About 20% of mothers who gave birth to twins are likely to suffer post-partum depression to some degree.

Antepartum depression can affect an unborn baby’s health, especially if the unborn mother is not eating or sleeping properly.

Postpartum depression can also affect a baby’s health, particularly if the mother is inattentive or even potentially dangerous to herself or the baby.

It is important for mother and loved ones to be aware of the signs and symptoms of pregnancy. These can include:

  • Debilitating sadness
  • Difficulty focusing
  • Changes in sleep or eating habits
  • Loss of interest in hobbies or activities
  • Anxiety
  • Thoughts of death or suicide
  • Feelings of guilt, worthlessness, or hopelessness

If you notice any of these symptoms, talk to someone; it can be a family member or a friend. Look for emotional support and seek out someone who can check in on you to make sure you are alright.

If symptoms progress, you may need to consider seeing a doctor.

Difference Between Standard and Twin Pregnancy

It isn’t difficult to surmise that a twin pregnancy is different from a singleton pregnancy. Not only is the number of babies different, but it also means more severe symptoms, more interaction with your doctor, and changes in your delivery.

As we touched on earlier, one of the first signs you may be pregnant with twins is the severity of your morning sickness

Due to the increased level of hormones necessary to help two babies grow, it is likely you will experience more nausea and vomiting during the first trimester than a mother carrying a single baby.

In addition to increased sickness, you can probably count on gaining a few more pounds with a twin pregnancy than with a singleton pregnancy. This is not only because of the extra baby but also due to the extra fluid and tissue necessary to keep your babies safe and healthy.

Weight gain isn’t the most fun thing about pregnancy, but there is a plus-side to being pregnant with twins.

It usually takes several weeks with a singleton pregnancy to look pregnant – most of the time not even until the second trimester (around 20 weeks or so) – you may start to look pregnant during your first trimester due to rate of your placenta and babies’ growths.

multiple pregnancy symptoms

In most cases, twins are born premature, usually around 37 to 38 weeks rather than 40.

Most twin deliveries are completed via C-section due to the complicated nature of vaginally birthing two babies. After all, they need to take turns and be positioned head-down.

However, vaginal birth is not an impossibility; they are simply only seen in about 1/3 of twin pregnancies.

Because of these increased risks, you need to be selective when choosing a doctor since you will likely be seeing them quite often. You will have more questions, undergo more tests, and will be more closely monitored than you would if you were only having one baby.

If you have a birth plan, discuss it with your doctor.

You will likely have to make some compromises due to the increased risks with twin pregnancy, but your doctor should also be able to talk you through those changes as well as find ways to support your birth wishes.

Finally, once you are nearing the finish line, your doctor will probably decide to put you on bedrest until it is time for delivery.

Twin pregnancy is considered high-risk, and with the extra weight and fluid as well as the risk for premature birth, your doctor will want you to take it easy either at home or in the hospital where you can be closely monitored.

Complications of a Twin Pregnancy

Twin pregnancy increases your risk for pregnancy-related health issues.

These can include:

  • Preeclampsia: two babies means two blood flows, which also means that mom’s heart is working twice as hard
  • Gestational diabetes
  • Premature birth: born before 37 weeksC-section
  • Miscarriage: vanishing twin syndrome, when one of the embryos is absorbed back into the body
  • Postpartum hemorrhage: larger placental area and an overly large uterus can contribute to extra bleeding

There are also increased risks for health issues with your babies, including:

  • Twin-to-twin transfusion syndrome: when blood flows unevenly from one placenta to both babies
  • Low birth weight: less than 5.5 pounds each, warranting a stay in the NICU
  • Birth defects: multiples have about two times the risk for congenital birth defects such as spina bifida, neural tube defects, and disorders of the brain and heart
  • Cord entanglementIntra-uterine growth restriction (IUGR): growth rate slows around 30 to 32 weeks due to the placenta and uterus not being able to handle any more growth
self care in pregnancy

Self Care During a Twin Pregnancy

With all the extra stress and strain on your body due to the growth of two babies rather than one, it is extremely important that you take care of yourself both for your sake and your babies’.

It is necessary for you to gain weight to help your babies grow and develop properly.

Make sure you eat a balanced diet and don’t skip meals, even if you are feeling sick. Skipping meals can lead to you feeling more nauseated.

It is also important that you stay hydrated as well, being sure you always have water with you wherever you go.

Start building your support system if you don’t have one in place already.

This means having people in your home and on call if you need anything during your pregnancy or after delivery. You will need to extra hands with two babies, especially so you can get some much-needed rest to recharge.

Make sure you attend all of your scheduled doctor appointments. Twin pregnancies are considered high risk; your doctor will need to monitor you closely and regularly, especially as you get closer to your due date.

You should also educate yourself on twins and twin pregnancy. You don’t want to feel unprepared for pregnancy, delivery, and life with two newborns.

FAQs

Can I exercise if I’m pregnant with twins?

It is generally safe to exercise when you are pregnant with multiples, but the type of exercise you want to engage in should be discussed with your doctor first.

Generally, you want to opt for things that are low impact that will also be comfortable with your growing belly. These can include swimming and aquatics, walking, yoga, and pilates.

Don’t push yourself too hard, especially since your heart is already working harder to account for an extra baby.

How accurate are tests for genetic disorders with twin pregnancies?

The short answer is yes and no. You will still undergo much of the same testing, but certain tests will not be as accurate when you are carrying more than one baby.

Your doctor may recommend different (but similar) tests for you if you are pregnant with twins as there are some that test for the same genetic defects with more accuracy in a pregnancy with multiples (i.e. NT screening rather than NIPT for Downs Syndrome testing).

Can I breastfeed with two babies?

While it is possible to breastfeed two babies – individually or tandem – it is safe to say that it will be challenging. Breastfeeding one baby takes a lot of commitment and sacrifice; two will require even more.

You should start by breastfeeding your babies one at a time to get to know them a bit, seeing how well they latch, how long they feed, and how they respond to the breast and breast milk.

Once breastfeeding has been established with each of your babies, you can then decide how it is best to feed them, whether you create a pumping/feeding schedule to feed them separately or choose to feed them both at the same time, one at each breast.

Should I see a special kind of doctor?

You don’t necessarily need to see a special type of OB/GYN, but you should be selective of who you see. Ideally, you will want to see a doctor that has experience delivering multiples.

Personality should also play a role in your decision since you will be spending a lot of time with them and asking a lot of questions.

In some cases, you may need to see a maternal-fetal medicine specialist.

These are classified as “high-risk” OB/GYNs. These doctors are able to start treatment before your babies are born if a health risk is discovered through testing.

When should I go on maternity leave?

Maternity leave can be a tricky subject depending on the company you work for and the country you live in.

Maternity leave is required to be given but doesn’t typically exceed 12 weeks (in the U.S.) and is not required to be paid (unless you have vacation time saved up).

When you do go on maternity leave in preparation for the birth of your twins should be decided between you and your doctor with your company’s guidelines considered.

However, medically speaking, it is recommended that you begin your maternity leave around 28 to 30 weeks since most twins are born early.

Are child birthing classes necessary if it’s likely the babies will be born via C-section?

It is still a good idea to take a child birthing class, especially if it is your first pregnancy. You may think you know enough about labor and delivery, but classes are much more in depth and they give you the opportunity to ask any last minute questions you may have.

There are some classes that are catered specifically to mothers/couples expecting multiples. Ask your doctor and check with your hospital to see if they offer one near you.

There are also some online (live) courses available, like Twiniversity, which may be an option if an in-person class is unavailable in your area.

Final Word

Twin pregnancy is full of excitement and surprises.

From the moment you find out you’re pregnant and you experience the early symptoms of sickness and fatigue, to the moment your suspicions are confirmed on a sonogram and you hear two separate heartbeats.

It can be a rough road when compared to a regular pregnancy.  So take care of yourself and be prepared for the ups and downs that come with having twins.

Questions or comments? Let us know!

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