How to know if you are expecting twins?

How to understand at the beginning of the pregnancy, if this is single or multiple, in short, if they are expecting twins?

There are situations when, even before doing the ultrasound, a twin pregnancy is suspected. Either because the symptoms of pregnancy are more evident, or because of  very high beta HCG values . My second pregnancy had stratospheric beta values ​​and I remember that once the gynecologist saw the results of the exam he said to me: “They could be twins, we’d better check carefully with the ultrasound”. I don’t hide that I had 5 minutes of panic! In those days I had unbearable nausea and at the moment everything seemed to make sense justifying it with a multiple pregnancy. Instead (and to my relief) it was simply my Francesco.

But are there actually signs of twin pregnancy?

Elevated levels of beta HCG

The beta HCG hormone is detectable in the blood of pregnant women or in the urine from 12 and 14 days after conception, respectively.  Their value increases rapidly  until the peak occurs at about 10 weeks of pregnancy. In twin pregnancies, a high level of beta HCG can be recorded, however, the standard level of this hormone for twins is also within the normal range for singleton pregnancies.

Excessive morning sickness

About 50% of pregnant women experience vomiting or nausea in pregnancy. Women expecting twins are not exempt but it is not said that they have to suffer doubly.

Fetal beat detector

Using a Doppler system, which amplifies fetal heart sounds, a trained doctor or midwife should be able to detect heartbeats even in multiple pregnancies. However, the sounds detected could be misleading in some cases: the second heartbeat detected could actually be background noise or, rarely, the mother’s own heartbeat.

Abnormal alpha-fetoprotein test results

The alpha-fetoprotein (AFP) test is a blood test that can be done on pregnant women during their second trimester. It is done to identify an increased risk of certain birth defects. A twin pregnancy can produce an unusually high value.

XXL measurement of fundus height

During pregnancy, your doctor or midwife can measure the fundal height (the distance that separates the top of the uterus from the symphysis pubis.) which can also be used as an indicator of gestational age. A twin or multiple pregnancy can cause the mother’s uterus to expand more than that of a singleton pregnancy. However there are also other factors that can increase the measurements.

Weight gain

A multiple pregnancy can cause more weight gain .

The kilograms gained during pregnancy vary depending on the mother’s height, body type and how much she weighed before pregnancy. A rapid or excessive increase is often the result of poor food choices. Typically, mothers of twins gain only about 5 kg more than mothers expecting a single child.

Frequent and early fetal movements

Some women report that in twin pregnancy fetal movements are perceived earlier or that they are more frequent than in single pregnancy. There is a lot of debate on the subject also because, if you think about it, even single pregnancies are precipitated differently from woman to woman: there are those who feel the first movements at 16-17 weeks and those at 22.

 Excessive tiredness

Pregnancy begins with a sense of exhaustion that characterizes the first weeks of gestation. Those expecting twins suffer more from this symptom precisely because her body is working overtime to feed more than one child


Is the possibility of conceiving twins hereditary? Yes, but only if we are dealing with heterozygous twins and only through the mother.


Obviously this is the safest method to confirm a multiple pregnancy. In fact, ultrasound is the only way to be sure of a twin pregnancy. In the first trimester, the doctor may find it difficult to identify the fetuses, especially if they are pregnancies with more than twins. In these cases, however, ultrasound scans starting from the second trimester should give definitive certainties

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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