Pregnancy Signs and Symptoms with Twins

And Alternative Explanations

Portrait of sleeping newborn baby girl lying besides her twin brother
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Are you experiencing pregnancy signs or symptoms of twins? Maybe you've conceived with the help of fertility treatments. Maybe you have a family history of twins, and you know your chances of having twins are higher!

Or, perhaps there's no specific reason (that you know of) that increases your odds of conceiving twins. You're just wondering about your pregnancy symptoms and thinking you may be carrying two.

You feel pregnant with twins.

Here's the bad news: you can't diagnose a twin, triplet, or any multiple pregnancy based on symptoms. The only way to confirm a twin pregnancy is with ultrasound. Keeping this in mind, here are some possible pregnancy signs and symptoms of a twin pregnancy.

Very Early Positive Pregnancy Test

If you get a positive pregnancy test result earlier than the day of your missed period, and the test is not an extra sensitive early results test, you may suspect twins. Or, if your test result is "very dark," you may assume this means you have higher amounts of hCG (the pregnancy hormone) in your system, and this is a possible early sign of twins.

However, at-home pregnancy tests are not a reliable way to determine a twin pregnancy. They aren't even good at determining the "stickiness" of a singleton pregnancy.

For one, at-home pregnancy tests can't tell you how much hCG is in your body.

It can only detect if you have a certain minimum amount.

Let's say you took several of the same test on the same day, at the same time. It is entirely possible that they will have varying levels of darkness (for the "positive" line result). Darker doesn't mean a "stronger" pregnancy nor does it indicate twins.

Secondly, the amount of hCG in your urine changes based on the time of day and how diluted your urine is. If you drank a lot of water, or you took the test in the later afternoon, you may not get a positive result on the very first day of your missed period, even if you are pregnant.

The tests simply aren't designed to detect these things.

Other possible causes for a very early positive pregnancy test result:

  • You may have miscalculated your missed period and not actually have taken the test too early.
  • Also, if you ovulated earlier than you usually do, you may be further along than you think.

High hCG Levels

Women who are receiving fertility treatments are more likely to have their hCG levels tested frequently during the early days and weeks of pregnancy.

This is not only to help confirm pregnancy success after treatment but also to monitor whether the pregnancy is progressing normally or at risk.

If your hCG levels are very high, you may wonder if it's twins.

But what is considered high? What is normal?

Levels of hCG can vary widely from pregnancy to pregnancy.  For example, the American Pregnancy Association lists the normal hCG range at five weeks from your last menstrual period to be anything between 18 mIU/ml and 7,340 mIU/ml.

Other possible causes:

  • Your hCG levels may appear higher than normal if conception occurred earlier than assumed.
  • In rare cases, high levels of hCG may indicate a molar pregnancy

Intense Morning Sickness

Mothers of multiples may experience intense morning sickness. (Or perhaps we should say all-day sickness!)  The nausea may begin very early, even before a positive pregnancy test comes back.

That said, not all mothers of multiples experience intense morning sickness. Some lucky women carry two or more babies without ever feeling nauseated.

Other possible causes:

  • Mothers of singletons can also experience intense morning sickness.
  • In fact, about 1 percent of pregnant mothers of singletons will experience severe morning sickness. The medical name for this condition is hyperemesis gravidarum.

Extreme Fatigue

Fatigue is a common early pregnancy symptom.  Women carrying twins or more may feel doubly (or triply!) tired.

Other possible causes:

  • Fatigue can be caused by a number of things, including trouble sleeping due to the excitement (or anxiety) of finally getting pregnant.
  • If you're taking progesterone supplements to help support the pregnancy, fatigue is a possible side effect.

Weepiness or Mood Swings

It's like a scene out of the movies: a pregnant woman, holding a box of tissues, crying about a Hallmark commercial.  Weepiness is a common pregnancy symptom, and moms of twins may be extra weepy.

Other possible causes:

Growing Large Quickly

If you're "measuring large for dates" or gaining weight quickly, you may be carrying twins.

Other possible causes:

  • If you've carried a pregnancy in the past, you're likely to show earlier. Don't be surprised if you look four months pregnant only six weeks past your last menstrual period.
  • It's also possible to measure bigger than expected if your baby is much bigger than average or if your date of conception has been miscalculated.
  • Don't forget to consider your diet, too.
  • If you're gaining weight quickly, it may just be that you're taking in more calories than you need.
  • Speak to your doctor for guidance on prenatal nutrition.

Feeling Fetal Movement Early

Most women don't feel fetal movements until at least 18 weeks.  Women expecting twins or more may report "fluttering" feelings earlier than this.

Other possible causes:

  • It could be gas. Fetal movements early on are difficult to distinguish from gastrointestinal upset.

Two Heartbeats Heard on Doppler

Sometimes, a second heartbeat is picked up by the fetal Doppler during a prenatal check-up. It could mean twins.

Other possible causes:

  • Or, it could be an echo.
  • Also, if you're using a fetal Doppler at home, you may actually be picking up your own heartbeat by accident.
  • (Your own heartbeat should be much slower than the average fetus's heartbeat. Still, it may be difficult for you to tell what you're hearing.)

A Word from Verywell

Many women wonder if they could be carrying twins, especially if their pregnancy symptoms are strong or they seem to be getting bigger faster.

Women who are pregnant with twins do tend to experience certain pregnancy signs and symptoms more intensely than women carrying a singleton pregnancy.

That said, there are plenty of women who have no idea they are pregnant with twins until a doctor discovers it during an ultrasound or questionable lab result.

If you have every symptom on this list, and you also have a high chance of being pregnant with twins, the likelihood of a twin pregnancy is higher than normal—but still not certain.

Conversely, if you have none of the symptoms on this list, and no reason to suspect a higher chance of conceiving twins, then you're less likely to have a twin pregnancy—but it's not impossible!

The only way to confirm a twin pregnancy is with an ultrasound. If you suspect twins, speak to your doctor about your signs, symptoms, and concerns.


Early Pregnancy - Including HCG levels and ultrasound findings. Advanced Fertility Center of Chicago.

Human Chorionic Gonadotropin (hCG): The Pregnancy Hormone. American Pregnancy Association.

Molar Pregnancy. American Pregnancy Association.

Multiple Pregnancies: Twins, Triples, and More. American Pregnancy Association.

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