The only way to confirm a twin pregnancy is by ultrasound. However, there are early clues that might point you to the possibility you are carrying more than one baby. Talk with your doctor if you suspect you might be pregnant with twins.
Early Signs and Symptoms
Several early signs and symptoms common to all pregnancies. However, some of them might be exaggerated if you are pregnant with twins or other multiple babies, likely because of higher hormone levels.
Severe Morning Sickness
Feeling wretched and can't keep anything down? Severe morning sickness early in your pregnancy, could be the first sign you might be carrying twins. A 2011 review in Gastroenterology Clinics of North America notes morning sickness, or nausea and vomiting of pregnancy, (NVP), during the first trimester of pregnancy is more common in women with a twin pregnancy. You are also more likely to have the severest form of morning sickness - hyperemesis gravidarum - according to MedlinePlus.
If you notice you have extreme fatigue during your pregnancy, it is possible you are pregnant with twins. Although fatigue is a common early pregnancy symptom, according to the University of Rochester Medical Center, it is said to be more severe in some women pregnant with twins than those carrying a single fetus. In addition, Beischer and MacKay's Obstetrics, Gynaecology and the Newborn (page 113) writes that women pregnant with twins continue to have increased fatigue throughout pregnancy.
Excess Weight Gain
You could be carrying twins if you not overeating but you are gaining weight quickly in the early first trimester, and you put on more than the one to two pounds weight gain recommended for all the first trimester. According to the textbook, Multiple Pregnancy: Epidemiology, Gestation and Perinatal Outcome, (page 300), women carrying twins have a more rapid and excess weight gain early in pregnancy than women pregnant with one baby.
Uterus Larger Than Dates
It is not possible for you to feel your normal pregnant uterus in your belly during the first trimester if you are pregnant with only one baby. However, if, for example, at six weeks from your last period you can already feel your uterus above your pubic bone, one explanation is a twin pregnancy. You might also notice that you are developing a pregnancy "bump" and have to start wearing maternity clothes earlier than expected.
Higher HCG Levels
If your doctor measures your pregnancy hormone (HCG) level early in your pregnancy, he might find it to be higher than expected if you are carrying twins. Your HCG rises soon after you conceive and according to Management of Common Problems in Obstetrics and Gynecology, tends to be higher in pregnancies with twins and other multiples.
High Blood Pressure
Although headaches are common in pregnancy and are most often benign in the first trimester, they could be caused by high blood pressure. If you are having frequent headaches early in your first trimester, see your doctor. You can find out if this could be a sign of early onset of high blood pressure or pregnancy induced hypertension (PIH), and if you might be pregnant with twins. High blood pressure is more common and tends to appear earlier in pregnancy in women bearing twins, according to a summary by the University of Rochester Medical Center.
Increased Chance of Twins
There are a few factors that increase your chance of having twins or other multiple gestation, according the American Society of Reproductive Medicine (ASRM). Having any of these factors combined with the above signs might cause you to pay closer attention to your early pregnancy signs and symptoms for the possibility of twins:
- Fertility drugs and assisted reproduction technology (ART): Women treated with fertility drugs or who undergo ART procedures, such as in vitro fertilization (IVF), have a greater chance of becoming pregnant with twins, according the ASRM reference. The possible signs and symptoms of twins are as outlined above but are more likely to be picked up sooner in these cases.
- Family history: A history of twins on your family tree or your partner's increases your own odds of becoming pregnant with twins and genetic factors might be involved.
- Advancing maternal age: The chance of twinning increases with age and is more likely in women over thirty.
- Previous history of twins: Your chance of having twins is greater if you already delivered a set.
- Prior pregnancy: You have a greater chance of becoming pregnant with twins with subsequent pregnancies than with the first.
If you have any early symptoms or signs of a possible twin pregnancy or any factors that increase your chance, discuss this with your doctor or midwife. A pregnancy ultrasound is the best way to get a confirmation during the first trimester. You will also be evaluated for other possible causes of these heightened signs and symptoms.