Is It Twins? Signs You're Pregnant With More Than One

Are you pregnant with twins? Some pregnant mothers suspect that they are carrying more than one baby, yet others are surprised. There are several signs and symptoms of twin pregnancy, but there is tremendous overlap with the signs of singleton pregnancies.

For some people, there is an increased chance of having twins or other multiples. These factors include:

  • A family history of twins - A history of multiples on the maternal side (but not paternal) of the family increases the chance.
  • A personal history of twins - It may sound like a joke, but women who have had one set of twins are more likely to have another.
  • Age - Women over the age of 35 are more likely to have twins than women who are younger. The chance increases even more after the age of 40.
  • Weight - Being overweight or obese increases the chance of having fraternal (non-identical) twins.
  • Height - Taller women are more likely to have twins than shorter women.
  • Race - African Americans are more likely than Caucasians to have twin births, whereas Asians, Native Americans, and Hispanics are less likely.
  • Breastfeeding - Women who are breastfeeding at the time of conception are more likely to have multiples.
  • Birth control pills - Women who have recently discontinued (or forgot to take) birth control pills are more likely to have multiples (fraternal only.)
  • Diet - Women who consume dairy products are more likely to have multiples than women who do not. Taking folic acid is also linked with a higher chance of multiples (but a lower rate of spina bifida.)
  • Season - Women who conceive in spring or summer are more likely to have multiples than those who conceive in the winter or fall.
  • Number of children - Multiples are more common in mothers who have previously given birth. The more children, the greater the chances that you will have twins the next time around.
  • Use of fertility medications - Clomid increases the chance by 5 to 12 percent, gonadotropins (injectable fertility drugs) inrease your chance by up to 30 percent and In vitro fetilization results in twins around a third of the time.

What are the most common signs that you are carrying twins? From morning sickness to blood tests, let's look at these signs and symptoms of multiples.

1
Elevated HcG Levels in Urine or Blood (Pregnancy Tests)

Pregnant woman holding baby booties
What are the signs that you might be having twins?. Paul Bradbury/OJO Images/Getty Images

It's usually difficult to distinguish a single pregnancy from twins on a urine pregnancy test. That said, you may have a very early positive pregnancy test if you are carrying twins. If you are using a regular pregnancy test (not the super-sensitive variety) and get an immediate positive (especially a very dark positive) a few days before your period is due, there may be an increased chance that you are carrying twins, but these tests are not very accurate. Chances are that an early or dark test simply means you have had less water to drink at the time you took the test.

A blood pregnancy test (hcG level), however, may give you an idea that you are carrying twins. HcG is a hormone detectable in pregnant women's blood or urine about 10 days post-conception and usually doubles every two to three days, peaking at about 8 to 11 weeks into the pregnancy.

Elevated hcG levels in early pregnancy aren't a common way to detect twins. One reason is that these levels are not frequently checked unless you are going through fertility treatment. Another is that the normal range of hcG can vary widely between different women. For example, levels between 18 mIU/ ml and 7,340 mIU/ml are considered "normal" at 5 weeks gestation. In addition to multiples, there are several causes of an elevated hcG level.

And, all of this assumes that your estimated due date is very accurate, which is also uncommon.

2
Doppler Heartbeat Count

Listening to heartbeats with doppler fetal monitor
Listening for two heartbeats. Oleksiy Maksymenko / Getty Images

Using harmless sound waves, a Doppler system amplifies fetal heart sounds, usually distinguishable late in the first trimester. An experienced physician or midwife may be able to detect more than one heartbeat, indicating a multiple pregnancy.

Listening to a baby's heartbeat early on in pregnancy, however, can easily be misleading. What appears to be a second heartbeat may actually be the same baby's heartbeat but heard from another angle (or as an echo.)

A mother's heartbeat is not usually mistaken for a baby as it is usually only half the rate of the baby's heart rate. The mother's heartbeat, however, may create background noise which makes it more difficult to distinguish the heartbeats of two or more babies.

3
Excessive Morning Sickness

There is a saying for twins that goes, "Twice as sick, three times as tired, and four times the weight gain" but this is, in many ways, an old wives tale. Statistically, moms of multiples may experience more morning sickness, but using the degree of morning sickness as an estimate that you are carrying twins isn't necessarily very helpful.

Overall, about half of women experience some amount of nausea and vomiting with singlets, and up to one percent experience hyperemesis gravidarum, a form of severe morning sickness. At the same time, some moms of twins and triplets say they have no morning sickness.

With a first baby, a woman doesn't have a reference point to compare her degree of nausea. With second babies and on, around 15 percent of women reported more morning sickness with multiples than with previous single pregnancies.

4
Weight Gain

While generally, mothers of twins only gain about 10 lbs. more than singleton mothers, the amount of weight a woman gains often depends more on her height, body type, and how much she weighed pre-pregnancy than the number of babies in her uterus. In addition, much of the increase in weight gain occurs later on in pregnancy, often after an ultrasound has already confirmed or excluded a diagnosis of twins or other multiples.

5
Abnormal AFP Test Results

AFP (Alphafetoprotein) screening is a blood test performed on pregnant mothers during the second trimester. Also known as maternal serum screening or multiple marker screening, it is used to identify increased risks of certain birth defects. A twin pregnancy can produce an unusually high, or "positive," result. Generally, your medical caregiver will respond by scheduling an ultrasound for further assessment. 

6
Measuring Large for Gestational Age

Throughout your pregnancy, your doctor or midwife will measure the height of your uterine fundus (measuring from the top of the pubic bone to the top of the uterus) as a way of estimating gestational age as well as the growth of the baby.

A twin or multiple pregnancy may cause the mother's uterus to expand beyond the range of a single pregnancy. However, other factors may also increase the measurements. This measurement is more difficult earlier in pregnancy than later on, when an ultrasound may have already detected the presence of twins.

7
Early Fetal Movement (or More Frequent Movement)

Feeling a baby—or babies—move inside the womb is one of the most thrilling aspects of pregnancy.

"Quickening," or the time at which you first feel your baby, can occur anytime between 18 and 25 weeks but is usually detected earlier in subsequent pregnancies, perhaps as early as 16 weeks. When women feel movement in early pregnancy it is often inconsistent and can be deceiving.

Although many moms of multiples do experience more frequent or earlier fetal movement, there is some disagreement among medical professionals on the subject. For some women, recognizable feelings of movement occur earlier in subsequent pregnancies, whether there is one baby or more.

8
Extreme Fatigue

Extreme fatigue is the most commonly reported complaint during pregnancy with multiples. Sleepiness, lethargy, and exhaustion during the first trimester can be enhanced because the body is working overtime to nurture more than one baby.

In some cases, the fatigue can be attributed to other factors (work, stress, poor nutrition, having other children), but it can also indicate multiples.

The degree of fatigue can, however, be difficult to assess, at least in relation to twins. We know that fatigue is almost inevitable in pregnancy, even with singletons. First-time moms don't have a reference point as to the "normal" degree of fatigue. Second-time (and more) mothers may note increased fatigue, but attribute this to the demands of having to care for young children while pregnant. Still, mothers who have had previous pregnancies may note that they are much more tired.

9
Gut Feelings and Hunches

While the other items in this list refer to some kind of visible evidence—exaggerated symptoms, abnormal test results, increased morning sickness and more—we can't disregard the power of a mother's intuition. Whether mothers-to-be have dreams of twins or a hunch they can't explain, those who have cared for pregnant women quickly learn to listen. Some of the best "hints" indicating a multiple pregnancy aren't easily explained in medical textbooks.

If you simply have a "gut feeling" that you may be carrying multiples, listen to your body and talk to your doctor about these feelings.

10
Ultrasound Confirmation

Ultrasound scan
Andersen Ross/Digital Vision/Getty Images

Seeing is believing. The only way to indisputably confirm a twin or multiple pregnancy is to see it via ultrasound. An ultrasound image can indicate without a doubt if there is more than one fetus. Ultimately, no matter what other signs or symptoms you have, the only way you'll know is to have an ultrasound.

If you have suspicions that there may be more than one baby, discuss your concerns with your medical caregiver. It is very unlikely that an ultrasound view would miss an additional baby, especially in the second or third trimester. However, there have been cases of hidden twins. A "hidden" twin is more likely to be present on an early ultrasound when the babies are identical (monochorionic) twins.​

Sometimes extreme higher order multiple pregnancies, such as quintuplets or sextuplets, are also too difficult to judge (count) accurately on an early ultrasound.

If You've Learned You Are Having Twins

If you've learned you have twins, don't panic. Certainly having twins is more challenging, but there are some clear advantages of having multiples.

Take a moment to check out our guide to twin pregnancy, including information on how to learn more and connect with other moms of twins, as well as these tips on having a healthy twin pregnancy.

Sources:

Chasen, S., and F. Chervenak. Twin Pregnancy: Prenatal Issues. UpToDate. Updated 05/10/17.

Khalil, A., Rodgers, M., Bashat, A. et al. ISUOG Practice Guidelines: Role of Ultrasound in Twin Pregnancy. Ultrasound in Obstetrics and Gynecology. 2016. 47(2):247-63.

Mackie, F., Morris, R., and M. Kilby. The Prediction, Diagnosis and Management of Complications in Monochorionic Twin Pregnancies: The OMMIT (Optimal Management of Monochorionic Twins) Study. BMC Pregnancy and Childbirth. 2017. 17(1):153.

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