Blonde woman holding pink and white pregancy test

Twin pregnancy symptoms

Twin Pregnancy Symptoms

One of the first questions a newly pregnant mother often asks is “Am I having twins?” And until it is confirmed that only one embryo is present, there is always the potential for this to be true.

For women who have a family history of twins, who have previously conceived with twins or have had fertility assistance, then the likelihood of having twins is higher. Because some types of fertility assisted conception do increase the likelihood of having a multiple birth, this is usually raised very early on in the pre-conception assessment and consent phases of treatment.

I’m having what?

Some women view the thought of having twins as being an absolute highlight, but others dread the possibility. Your own perception will be influenced by your personal experiences, history and supports.

For women who have been informed of the risk, or who have a history of twins in their biological family, having their own twin pregnancy confirmed is not such a shock. But for women who did not expect to conceive with more than one baby or who may not have been planning to conceive at all, then finding out they are pregnant with twins can come as a real surprise.

Denial, shock, feeling numb and even angry are common emotions in the early days of having a twin pregnancy diagnosis. Others may feel excitement at the thought of double the love and double the joy. With time reality soon descends and most women learn to accept the fact that they are having two babies.

What’s so different about being pregnant with twins?

Twin pregnancy symptoms are not so much different to normal pregnancy symptoms, but they are felt much earlier. For the stage of gestation, twin pregnancy symptoms tend to be felt more clearly and with more emphasis before the normal gestational age and stage.

It is important to remember that just as every woman is unique and her pregnancy highly individual, there are some “classic” or standard symptoms which are attributed to twin pregnancy. Many of these are due to the elevated and more concentrated levels of hCG (Human Chorionic Gonadotrophin Hormone) which is the pregnancy hormone. It is primarily responsible for sustaining the embryo and maximising its chances of survival.

When twin pregnancy is more likely:

  • For women over 30 years of age.
  • In women who are peri-menopausal twins are more common.
  • In women who are taller than average, the odds are higher for having a twin pregnancy than for those of average or shorter height.
  • Women who are overweight with a BMI (Body Mass Index) of >25.
  • If you have a history of already having twins or if there are twins in your biological family e.g. your mother, aunts or sisters have had non-identical (fraternal) twins.
  • If you have had fertility assistance to conceive.
  • For women who have been pregnant previously.

Symptoms of twin pregnancy

  • Some women will “just know” they are pregnant with twins. This may be before they have even had confirmation that they are pregnant. They may dream, sense or have a vision or inherent belief that they are pregnant with twins.
  • Some women will be told they are pregnant with twins by their partner, relatives, family or very close friend. Although there is often no evidence to support this claim, when their twin pregnancy is confirmed it really comes as no surprise.
  • Feeling very nauseous from early in the pregnancy. This is sometimes so extreme that the mother finds it difficult to tolerate anything but the blandest, easiest to digest foods.
  • Extreme intolerance to foods, smells, textures and appearance of some foods. Commonly meat, seafood, coffee and tea are the first substances to be found repugnant.
  • The uterus is “large for dates” which reflects the fact that two embryos, rather than one is present.
  • Extreme breast tenderness – to the point where it may be too uncomfortable to wear a bra. Some women find they need to wear crop tops or bandeau style tops as an alternative until their breasts become more comfortable.
  • Wanting and needing to pass urine much more frequently. Although urinary urgency is a common early pregnancy symptom, when pregnant with twins, this is much more magnified.
  • Utter exhaustion and a feeling of being unable to get through each day. This again, is a common pregnancy symptom but is exacerbated during a twin pregnancy.
  • Higher levels of hCG. This may be reflected in a very early pregnancy urine test. Even before a missed period, the level can be so high that there is an immediate, strong and clear positive confirmation on the pregnancy testing stick. For women who have undergone fertility assistance, blood tests may reflect a very high concentration of hCG early after conception.
  • Some women will experience more uterine cramping which is not associated with any blood loss. This can be a symptom of round ligament pain and is due to the uterus expanding relatively quickly.
  • A sense that your heart has to work harder than it usually does. Many women are aware that their resting heart/pulse rate is higher than normal. This is a sign of their heart having to pump out a greater blood volume with each heart muscle contraction in order to supply the uterus with oxygen saturated blood.
  • Moodiness, being prone to tears and feeling mentally unstable are common pregnancy symptoms, but when pregnant with twins, they tend to be more extreme.
  • You may find you can feel your baby/babies moving much earlier in your pregnancy. Women who are pregnant with twins say that they are conscious of feeling movements, known as quickening, earlier than the standard 15-16 weeks.

How is a twin pregnancy confirmed?

Although you, your partner or your health care practitioner may suspect you are pregnant with twins, it is not until twins are confirmed that you can be 100% sure.

  • Ultrasound, where two embryos are clearly defined on the screen.
  • Hearing two, separate heartbeats on a Doppler.
  • In the absence of sound ante-natal care, it is still possible that a twin pregnancy may not be evident until two babies are born.

Complications of a twin pregnancy

Unfortunately, the overall risks of pregnancy are increased during a twin pregnancy. But many women have an uneventful gestation and just because you are pregnant with twins, is not a guarantee you will have complications. But it does help to be informed and keep an open mind.

  • Premature birth – e.g. before 38 weeks of gestation.
  • Smaller babies with lower birth weight – simply because there have been two growing in the same space.
  • One baby which is smaller than the other. It is common during twin pregnancy for one twin to receive more nutrition and space allocation than the other.
  • Pre-eclampsia. Therefore, it is so important for you to have your BP monitored during your pregnancy. Fluid retention and passing protein in urine are other signs of pre-eclampsia.
  • Gestational diabetes.

What’s important to remember if pregnant with twins

  • Regular ante-natal care with a qualified health care practitioner is essential.
  • It may be worthwhile seeing an accredited practicing dietician to receive evidence based information on diet and meeting your body’s nutritional demands. Allow yourself plenty of opportunity to rest. Growing twins and supporting them towards maturity takes a lot of energy. You may need to consider your work/leave entitlements and arranging regular home support and child care for older children.
  • You may need to have more regular ultrasounds than if you were carrying one baby.
  • Your healthcare rebate and entitlements may be affected; find out early in your pregnancy what you are covered for or consider accessing the public health system. Premature baby care can be extremely expensive. Find out your status and coverage early in your pregnancy to avoid unwanted and avoidable expenditures.
  • Plan for an earlier than expected delivery. Twins have a habit of coming early and it pays to be well organised.


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