Early Signs You May Be Pregnant with Twins

Pregnancy has a funny way of making the internet your new best friend. One minute you’re searching, “How much coffee can I drink?” the next it’s, “Am I having twins?”

If you’ve been wondering whether your early pregnancy symptoms could point to multiples, you’re in the right place. Michael Leonardi, MD, maternal fetal specialist, explains what those early signs may mean and when you’ll know for sure.

How do twins happen?

There are two main types of twins and each develops a little differently.

Identical Twins

Identical twins happen when one fertilized egg splits into two embryos early in pregnancy. Because they come from the same egg and sperm, identical twins share the same DNA and are always the same sex.

Fraternal Twins

Fraternal twins happen when two separate eggs are released during ovulation and each is fertilized by a different sperm. Just like any other siblings, they share about 50% of their DNA and can be the same sex or different sexes.

Signs of Twins or Multiples During Early Pregnancy

While it’s tempting to compare notes about your pregnancy symptoms with moms of multiples, the signs and symptoms may vary from person to person.

Many women carrying one baby experience the same symptoms as moms of multiples, while some moms expecting twins have very typical pregnancies. That’s why these early signs of twins can offer clues, but they can’t give you a definitive answer.

The only way to know for sure if you’re expecting multiples is through an ultrasound.

Stronger Pregnancy Symptoms

One of the most common reasons women begin to wonder if they’re expecting twins is because their pregnancy symptoms feel especially intense.

Some women carrying multiples experience:

• Frequent nausea and morning sickness
• Extreme fatigue
• Severe breast tenderness
• Strong food cravings or aversions

Twin pregnancies often produce higher levels of pregnancy hormones, which may contribute to more noticeable symptoms.

“Many of the old wives’ tales you’ve probably heard that feeling ‘more pregnant’ means you’re expecting twins do have a kernel of truth,” said Dr. Leonardi. “But there’s so much overlap with single pregnancies that symptoms alone aren’t a reliable way to tell.”

Higher hCG Levels

Human chorionic gonadotropin (hCG) is the hormone detected by pregnancy tests. In general, pregnancy hCG levels for twins tend to be higher than those of single pregnancies.

However, hCG levels have a wide range of what’s considered normal. Even if your levels are above average, bloodwork alone can’t tell whether you’re carrying one baby or more.

You may have also heard that twins can cause a false negative pregnancy test. While this is very rare, extremely high hCG levels can occasionally overwhelm a pregnancy test, resulting in what’s known as the “hook effect.” For most pregnancies, however, home pregnancy tests are considered extremely accurate when used correctly.

What factors increase your chance of having twins?

While many twin pregnancies happen without a known reason, a few factors can increase your likelihood of having multiples.

Family History

Fraternal twins can run in families because the tendency to release more than one egg during ovulation can be inherited, particularly on the mother’s side. If you inherit that trait, you may be more likely to conceive fraternal twins.

Identical twins, on the other hand, happen when a single fertilized egg randomly splits into two embryos. Researchers don’t know exactly why this happens, and it’s generally not thought to be inherited.

Another common misconception is that your partner’s family history determines whether you’ll have twins. While a father can pass along genes that may increase his daughters’ chances of having fraternal twins one day, his family history doesn’t affect whether you release more than one egg during your pregnancy.

Maternal Age

Age can also influence your chances of having fraternal twins. As women get older, particularly after age 30, they’re naturally more likely to release more than one egg during ovulation. This increases the chance of conceiving fraternal twins.

Fertility Treatments

Certain fertility treatments, such as in vitro fertilization (IVF), can also increase the chance of twins or other multiples. Medications that stimulate ovulation may cause the ovaries to release more than one egg, increasing the likelihood for multiples.

What are the odds of having multiples?

While most pregnancies involve one baby, twins are more common than many people think. About 3% of live births are twins, or roughly 1 in 33 births. Triplets and higher-order multiples are much less common, occurring in about 71 out of every 100,000 live births, or roughly 1 in 1,400 births.

When do twins show up on ultrasound?

Most pregnant women will have their first ultrasound around eight weeks of pregnancy. During this scan, your provider can typically determine how many babies are developing, estimate your due date and begin planning the prenatal care that’s right for your pregnancy.

“On the rare occasion we can’t clearly see both babies, it’s usually because the pregnancy is still very early or a baby’s position limits what we can see,” said Dr. Leonardi. “If your provider suspects multiples but can’t confirm it right away, they’ll likely recommend another ultrasound.”

If You’re Expecting Multiples

If your ultrasound reveals you’re expecting twins or another multiple pregnancy, your prenatal care may look a little different than someone carrying one baby.

You can expect a few additional prenatal appointments and ultrasounds throughout your pregnancy. These visits allow your care team to monitor each baby’s growth and development, check on your health and identify any concerns early. The extra attention is designed to support a healthy pregnancy and give both you and your babies the best possible start.

“Parents are often surprised to learn they’ll have more appointments, but those visits are one of the biggest advantages of a multiple pregnancy,” said Dr. Leonardi. “They give us more opportunities to monitor babies closely, get to know you and your family and answer questions along the way.”

As you prepare for your babies’ arrival, it’s also worth considering where you’ll deliver. Because twins and other multiples are more likely to arrive early, many families choose a hospital with advanced newborn care, including a Neonatal Intensive Care Unit (NICU).

While many twins are born healthy and need little or no specialized care, choosing a hospital with these services means experienced specialists are available if they’re ever needed, giving you one less thing to worry about.