6 Signs You Might Be Pregnant With Twins

Early on in any pregnancy, there are often a lot of questions. What sort of personality will my baby have? Who will they look more like? And, of course, the ultimate: Am I carrying twins?

When people are pregnant with twins, they experience a wide range of pregnancy symptoms, just like those with singleton pregnancies do. That said, certain physical signs might clue you in to how many babies you're expecting, like intense morning sickness and "showing" earlier than expected. We turned to the experts to learn more about the signs of twins and how you might be able to tell early on that you've got more than one baby on the way.

Elevated hCG Levels

Higher-than-normal levels of hCG may indicate that you're pregnant with multiples, but you'll need to wait until your ultrasound to be 100% certain. When you become pregnant, your body starts making human chorionic gonadotropin hormone (hCG). Levels surge in the first few weeks of pregnancy.

While home pregnancy tests detect hCG in urine to confirm pregnancy, they cannot tell you how much hCG your body is producing. Only an hCG blood test, like the one done at your doctor's office, can provide a look at the levels of hCG in your body at a given point in time.

Even then, high hCG levels in early pregnancy don't mean that multiples are a sure thing. "Twin pregnancies often have increased hCG levels, but so do some singleton pregnancies," says Amos Grünebaum, M.D., a professor of obstetrics and gynecology at the Zucker School of Medicine in Hempstead, New York, and the founder of BabyMed, a conception and pregnancy education website, and Obie, a science-based fertility app. "There is a wide range of normal hCG levels both for twins and singletons, and it's impossible to be sure it's twins even when the early hCG levels are elevated."

Exaggerated Pregnancy Symptoms

Since many pregnancy symptoms are caused by hormonal changes, it makes sense that people expecting twins (who often have more substantial hormonal changes than people expecting just one baby) can experience more severe symptoms.

"When a person is pregnant with twins, they're at a higher risk for many things happening, over [someone one who is pregnant with] singletons," says Christine Greves, M.D., an OB-GYN at Winnie Palmer Hospital for Women & Babies in Orlando, Florida.

Common early pregnancy symptoms include:

• fatigue
• frequent urination
• breast tenderness
• food cravings

Intense Nausea and Vomiting

Due to elevated levels of hCG, people carrying multiples may experience more nausea and vomiting than those carrying only one baby, explains Dr. Greves. Hyperemesis gravidarum, a condition that's often compared to morning sickness (but is infinitely more severe), is also more likely with a multiple pregnancy. It causes nausea and vomiting so severe that a person may need intravenous (IV) fluids and other assistance, Dr. Greves says.

A Bigger "Bump"

Dr. Grünebaum says that speedy weight gain isn't a definitive indicator of twin pregnancy because height, pre-pregnant weight, diet, and body type also come into play. However, many who have carried multiples say their quickly growing bellies tipped them off.

One or More Twin Risk Factors

Certain people have a greater chance of getting pregnant with twins than others. Some factors that can raise your odds include:

• Family history of fraternal twins
• Advanced maternal age (over 35 years old)
• BMI over 30
• Using ovulation induction medications like clomiphene or letrozole, which are associated with a 10% risk of multiple gestation
• Above-average maternal height
• History of previous pregnancies

Intuition

Just as some people have a hunch they're pregnant, others might instinctively guess they're expecting twins. You can't deny your instincts!

The Bottom Line on Twin Pregnancy Symptoms

It can be fun to guess whether you're carrying multiples. But no matter how many twin pregnancy symptoms you're experiencing, you need an ultrasound to determine how many babies you're carrying.

"You can guess as much as you want, but until you have the ultrasound examination, it's all just speculation," affirms Dr. Grünebaum. Luckily, most parents don't have to wait long to know for sure. "Today, twins can usually be diagnosed as early as six to seven weeks into the pregnancy," he says. As with anything else concerning pregnancy, if you have questions about your growing baby (or babies), be sure to reach out to an OB-GYN or health care provider.