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What precautions should be taken during twin pregnancy?

Pregnant with twins: what to expect

Is it normal to feel anxious about expecting twins?

It’s perfectly normal. Finding out that you’re expecting twins may come as a bit of a shock. Even if you suspected you’d conceived twins because of your family history or fertility treatment, it can still take time to adjust.

It’s natural to worry about complications with your pregnancy or birth. In fact, most mums expecting twins or more give birth to healthy babies, and serious complications are relatively rare (McAslan Fraser 2012) .

You should see an obstetrician and midwives who are experienced in twin pregnancies. They’ll do their best to ease any worries you may have. Your health and your babies’ health will be carefully monitored throughout your pregnancy (NCCWCH 2011, NICE 2011) .

Expecting multiples can make you more vulnerable to anxiety or depression during pregnancy (NCCWCH 2011, Vilska et al 2009) . Some twin mums-to-be worry about body image, because it’s normal to put on extra weight with twins.

Whether you’re affected by depression does depend on your circumstances, though (NCCWCH 2011) . If you are pregnant with twins as a result of assisted conception, for example, you are less likely to become depressed during pregnancy than a woman who conceived twins unexpectedly (Vilska et al 2009) .

Talk to your midwife or doctor if you are feeling down about your pregnancy (NICE 2011) . They will understand how you are feeling and offer suggestions or support from a specialist, if you need it (NCCWCH 2011) .

There’s help available, too, if you’re feeling overwhelmed at the prospect of coping with more than one newborn at once. Ask your midwife about attending antenatal classes specially for multiples. This will prepare you for life as a parent, and you’ll meet other parents-to-be in the same situation as you, giving you a vital support network.

Will I have different care if I’m pregnant with twins?

Yes. You’ll be offered more antenatal appointments, tests and scans than if you were carrying one baby. Your doctor or midwife should explain what each test or scan is for, and why you need it (NCCWCH 2011) .

The exact number of appointments and scans depends on:

  • Your individual situation.
  • Your hospital’s policies regarding multiples pregnancies.
  • Whether you’ve experienced pregnancy complications.
  • Whether or not your babies share a placenta (monochorionic twins). Monochorionic twins are more likely to experience complications than twins who each have their own placenta.
    (NCCWCH 2011, NICE 2011)

You’ll have regular blood pressure and urine checks. That’s because women expecting twins have a higher risk of developing high blood pressure and pre-eclampsia (NICE 2011) .

If your midwife thinks there’s a chance you could develop gestational diabetes, she’ll offer you a glucose tolerance test (GTT) later in pregnancy (NCCWCH 2011) .

Your midwife will also offer you an extra blood test for anaemia when you are between 20 weeks and 24 weeks pregnant, as well as the test all pregnant women have at 28 weeks (NCCWCH 2011, NICE 2011) .

You’re more likely to give birth by caesarean section. If you’d like to try for a vaginal birth, raise it early on with your obstetrician. Then you’ll have plenty of time to discuss and think through your birth options. Many mums of twins have a vaginal birth (NCCWCH 2011) .

Are pregnancy symptoms worse with twins?

You may have stronger pregnancy symptoms if you’re expecting twins, but it’s not a given (McAslan Fraser 2012) .

You’re more likely to have light bleeding or spotting in early pregnancy than in singleton pregnancies. So this may reassure you if you do have some spotting.

However, sadly, it’s also true that miscarriage rates are higher in multiple pregnancies. If the spotting gets heavier and you get cramps too, the safest option is for you to visit an early pregnancy assessment unit (EPAU). See or call your doctor or midwife as soon as possible, so they can refer you to your nearest EPAU.

You may feel very nauseous. With two babies growing inside you, your levels of the pregnancy hormone human chorionic gonadotropin (hCG) are higher (NICE 2013, McAslan Fraser 2012) .

You’ll also feel the effects of higher levels of the hormone progesterone, which can:

  • Make you feel short of breath, especially early on in pregnancy (Jensen et al 2010, McCormack and Wise 2009) .
  • Cause heartburn and indigestion by relaxing your muscles.
  • Cause constipation, often made worse if you have to take iron tablets for anaemia (McAslan Fraser 2012) .

If you experience back or hip pain as your pregnancy progresses, ask your midwife to refer you to a women’s health physiotherapist (NCCWCH 2011) .

If the thought of all these pregnancy symptoms is getting you down, read 20 reasons why it’s great to have twins.

Which worrying pregnancy symptoms do I need to watch out for?

The danger signs to look out for are the same as in any pregnancy. But do be alert to any unusual symptoms.

Trust your instincts, and if you’re not sure about a symptom, or just don’t feel right, call your midwife or doctor. Keep a close eye on your babies’ movements. Depending on how they’re lying, you should soon get to know their usual pattern of movements. If they start to move around more than usual or less than usual, call your hospital.

It’s always worth checking if you have any concerns, because the risk of complications is higher when you are expecting twins. It’s most likely your midwife will reassure you’re fine, as serious complications are uncommon and the vast majority of twins are born healthy.

Premature birth, before 37 weeks, happens in more than half of twin pregnancies (NCCWCH 2011) . Call your midwife if you think you are in labour, or if you are really worried, call your maternity unit direct to arrange to go straight to hospital.

Pre-eclampsia is more common in women who are expecting twins (NCCWCH 2011) . It’s a potentially serious complication, related to high blood pressure, that needs immediate medical attention.

Pre-eclampsia is usually picked up by the blood pressure and urine tests that take place during your antenatal appointments. Between appointments, call your midwife straight away if you have:

  • a severe headache at the front of your head that doesn’t ease with over-the-counter painkillers
  • vision problems, such as blurring, or flashing lights before your eyes
  • pain in your upper abdomen
  • vomiting
  • sudden swelling of your feet, ankles, face and hands
    (NCCWCH 2011)

Will I gain more weight if I am expecting twins?

You are likely to put on more weight than if you were pregnant with just one baby (Mc Aslan Fraser 2012) . Try not to feel disheartened about this. Gaining extra weight is normal in twin pregnancies. You need the weight to help your babies grow well and to give you the energy for labour and birth.

As in any pregnancy, try to eat a healthy diet to provide you and your babies with the right nutrients (NCCWCH 2011) .

How can I cope with a twin pregnancy?

You’ll need to take it easy, as you will be tired while carrying two babies (McAslan Fraser 2012) . You shouldn’t need extra bed rest (NCCWCH 2011, NICE 2011) , but put your feet up when you can. Sleep may be hard to come by as your pregnancy progresses (McAslan Fraser 2012) , which will add to your tiredness.

Make rest a priority. If you have older children, ask a friend or relative to look after them occasionally, so you can rest. If you’re working, have a rest at the end of the day, before getting on with your evening.

It will actually boost your energy levels during the day and help you sleep at night if you take gentle exercise (McAslan Fraser 2012, NCCWCH 2011) . Yoga, Pilates or swimming are ideal. But check with your doctor or midwife before starting any new exercise programme. You don’t want to put a strain on your body.

If you’re working, consider taking maternity leave as early as you can. Most mums-to-be of multiples stop work at 28 weeks. This makes sense because carrying twins is hard work, and most twins arrive earlier than single babies (NCCWCH 2011) .

More than half of twins are born before 37 weeks (HSCIC 2015, ISD Scotland 2014) and it’s very common for at least one baby to need a stay in special care (Tamba 2012) . Going to a twins-specific antenatal or parenting class may help you to prepare (Tamba 2012) . Try to book on a course that starts in the second trimester or very early third trimester.

Work out the timing so that you have the best chance of completing the course before 34 weeks pregnancy, if you are expecting twins, or before 30 weeks if you are expecting triplets (McAslan Fraser 2012) .

Where else can I find support?

If you’re having twins or more, it’s important to ask for help. If friends and family offer to lend a hand, let them. If they don’t offer to help, ask. It’s worth contacting a support group for advice and to meet other mums of twins.

The Twins and Multiple Births Association (Tamba) and the Multiple Births Foundation offer information and local support networks for families with twins or more.


Anderson-Berry AL, Zach T. 2014. Vanishing twin syndrome. Medscape. [Accessed October 2015]

HSCIC. 2015. NHS maternity statistics, 2013-14: maternity statistics tables. Health and Social Care Information Centre, Hospital Episode Statistics [Accessed October 2015]

ISD Scotland. 2014. Live births (all, singleton and multiples) by birthweight and gestation. Information Services Division. [Accessed October 2015]

Jensen D, Webb KA, O’Donnell DE. 2010. The increased ventilator response to exercise in pregnancy reflects alterations in the respiratory control systems ventilator recruitment threshold for CO2. Respir Physiol Neurobiol 171(2):75-82

McAslan Fraser E. 2012. Expecting twins, triplets or more: the healthy multiple pregnancy guide. Tamba (Twins & Multiple Births Assocation). [Accessed October 2015]

McCormack MC, Wise RA. 2009. Respiratory physiology in pregnancy. In: Bourjeily D, Rosene-Montella K. eds. Pulmonary problems in pregnancy Springer: Humana Press 19-26

NCCWCH. 2011. Multiple pregnancy: the management of twin and triplet pregnancy in the antenatal period. National Collaborating Centre for Women’s and Children’s Health, NICE Clinical guideline. London: RCOG Press. [Accessed October 2015]

NICE. 2011. Information for the public: antenatal care for women who are pregnant with twins or triplets. National Institute for Health and Clinical Excellence. [Accessed October 2015]

NICE. 2013. Nausea/vomiting in pregnancy. National Institute for Health and Care Excellence, Clinical Knowledge Summaries. [Accessed September 2015]

Ross LE, McQueen K, Vigod S, et al. 2011. Risk for postpartum depression associated with assisted reproductive technologies and multiple births: a systematic review. Hum Reprod Update 17(1): 96-106. [Accessed October 2015]

Tamba. 2012. Tamba twins & multiples healthcare survey: making progress. Twins and Multiple Births Association. [Accessed October 2015]

Vilska S, Unkila-Kallio L, Punamaki RL, et al. 2009. Mental health of mothers and fathers of twins conceived via assisted reproduction treatment: a 1-year prospective study. Hum Reprod Update 24(2):367-77. [Accessed October 2015]

Wenze SJ, Battle CL, Tezanos KM. 2015. Raising multiples: mental health of mothers and fathers in early parenthood. Arch Womens Ment Health 18(2):163-76

6 Signs You Might Be Pregnant With Twins

Think you’re carrying more than one baby? These twin pregnancy symptoms could potentially indicate multiple buns in the oven.

Updated on September 22, 2022

When people are carrying multiples, 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. Check out these early twin pregnancy symptoms that could hint at multiple babies-to-be.

Possible Signs of Twins

Early on in your pregnancy, there may not be obvious signs of twins. However, some people may experience signs they are pregnant with twins that include early and severe morning sickness and showing early. Some people also have an intuition that they are having twins or have a family history of twins so they may suspect twins are possible. Here are six more signs of twins you may experience.

1. 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.»

2. 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, and food cravings.

3. 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.

4. A bigger, earlier 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.

5. 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

6. 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 really 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.

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