Twin Pregnancy: Signs and Symptoms

Am I Pregnant with Twins?

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 multiple babies to have been conceived. The most accurate way to confirm twin pregnancy is by ultrasound, by as early as six to seven weeks. Some women will experience twin pregnancy symptoms shortly after conception. A very high, early hCG reading can raise suspicion there may be a twin pregnancy.

For women who have a family history of twins, who have previously conceived with twins or had fertility assistance, the likelihood of having twins is higher. Some types of fertility assisted conception increase the likelihood of having a multiple birth. This is generally discussed early on as a risk factor during pre-conception assessment and fertility treatment. 

I’m having what?

Some women view the thought of having twins as being an absolute joy, others less favourably. Your own perception will be influenced by 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, their own twin pregnancy confirmed may not be such a surprise.

Denial, shock, feeling numb excited and even angry are common emotions in the early days of having a twin pregnancy diagnosis.

What’s so different about a twin pregnancy?

Twin pregnancy symptoms are not so much different to normal pregnancy symptoms, but more exaggerated, especially in the first trimester. Twin pregnancy symptoms tend to be felt more clearly and earlier.

Though every woman is unique and her pregnancy individual, there are some standard twin pregnancy symptoms. Many are due to the elevated levels of hCG (Human Chorionic Godanotrophin) hormone - the pregnancy hormone. This is responsible for sustaining the embryo and maximising its chances of survival. 

 hCG levels vary between women and their own body’s unique response to pregnancy. Levels of hCG tend to peak at around weeks 10-12 or pregnancy, before they level off or decrease.

When is twin pregnancy more likely?

• In women over 30 years of age.
• Women who are peri-menopausal.
• Taller than average women where the odds are higher for having a twin pregnancy than women of average or shorter height.
• Women who are overweight with a BMI (Body Mass Index) of >25.
• Women with a history of already having twins or, where there are twins in their biological family e.g. mother, aunts or sisters having had non-identical (fraternal) twins.
• For women who’ve had fertility assistance. 
• Women of African American descent.
• For women who have been pregnant before.

What are symptoms of twin pregnancy?

• Some women will “just know” they are pregnant with twins. This may be before they have even had confirmation they’re pregnant.
• Some women will be told they have a twin pregnancy by their partner, relatives, family or very close friend. Although there is often no evidence to support this claim.
• 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 foods found repugnant.
• The uterus is “large for dates”, reflecting 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.
• Needing to wee much more frequently. Although urinary urgency is a common early pregnancy symptom, during early twin pregnancy it’s particularly noticeable. 
• Exhaustion and a feeling of being unable to get through each day. This again, is a common pregnancy symptom but is worse 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 fairly quickly.
• Moodiness, being prone to tears and feeling mentally unstable are common pregnancy symptoms, but when pregnant with twins, they tend to be more extreme.
• Movements felt early on in the 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 won’t be until twins are confirmed that you can be 100% sure. In the early weeks of a twin pregnancy, it’s unlikely your maternity care provider will recommend you do anything special. But as your pregnancy advances, you may need more regular ante-natal appointments and scans to monitor your own as well as your babies’ health. 

• Ultrasound, where two embryos are clearly seen on the screen.
• Hearing two, separate heartbeats on a Doppler.
• In the absence of good ante-natal care, it is still possible that twins may not be detected until they are born. 

Complications of a twin pregnancy

• Unfortunately, the overall risks of pregnancy are increased during a twin pregnancy. But many women have a straightforward pregnancy without complications.
• Premature birth – e.g. before 37 weeks of gestation.
• Smaller babies with lower birth weight – simply because there have been two growing in the same space.
• Twin to twin transfusion. 
• One baby which is smaller than the other. It is common during twin pregnancy for one twin to receive more nutrition and take up more space than the other one. 
• Pre-eclampsia. It’s important for all pregnant women to have their blood pressure (BP) monitored. Fluid retention and protein in urine are other signs of pre-eclampsia.
• Gestational diabetes.

What’s important to remember during twin pregnancy

• It’s essential to have regular ante-natal care with a qualified health care practitioner. 
• It may be worthwhile seeing an accredited practicing dietician to receive evidence based diet information. 
• Allow plenty of opportunity to rest. Growing twins 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.
• Plan for an earlier than expected delivery. Twins have a habit of coming early and it pays to be well organised. 

Written and reviewed by Jane Barry, midwife and child health nurse on 1/01/20.