Symptoms of Pregnancy with Twins

What's Covered

Some mothers can suspect that they are pregnant with twins from the beginning. Yet others get surprised when they get the ultrasound results. It is important to note that while several symptoms indicate twin pregnancy, these symptoms can as well be present in singleton pregnancies.

Gauging how you feel or over-interpretation of some home test might not accurately point out to twin pregnancy. It is only an ultrasound that can give an accurate result of the number of fetuses you are carrying.

However, here are some hints or symptoms of twin pregnancy week by week.

1to 4 weeks symptoms of pregnancy with twins

This is the stage at which the twins are formed. For the identical twins, it’s only one egg that gets fertilized forming a zygote. The zygote then splits into two forming two embryos during this early stage of pregnancy. Identical twins have similar chromosomes, they are of the same sex and they resemble each other physically.

For the fraternal twins, two eggs get fertilized by two different sperms. Fraternal twins are not identical and can be of different sex.

It is also during this stage when implantation takes place in the womb and the placenta for each baby begins to form.

Some of the symptoms during this stage will include:

Breast tenderness

Hormonal changes during pregnancy can cause breasts to be swollen, tender and painful. This can be a bit extreme during twin pregnancy. This is all attributed to the HCG hormone that is present during pregnancy.

To minimize the pain in the breasts you can consider wearing softer bras instead of tight ones and avoid any activity that causes your breasts to race like jumping or running. You can also ask your partner to stay away from your breasts for some time until the pain subsides.

Implantation breeding

You might notice some light spotting when the fertilized eggs are getting attached to the lining of the uterus. This usually takes place two weeks after fertilization.

5 to 8 weeks symptoms of pregnancy with twins

At this moment the major organs are beginning to form: the brains and the spinal cords are forming, the little arms are coming up, the lungs and the genitals forming. At this stage, the two heartbeats are developing.

The signs to look out to at this stage will be:

Extreme morning sickness

Some twin pregnancies are characterized by severe nausea and vomiting unlike in singleton pregnancy.[1] Observations also indicate that nausea and vomiting start early for twin pregnancies, even before pregnancy is detected through a test.

Here are some tips for reducing nausea:

  1. Healthy balanced diet

In some instances, this is usually easier said than done. Incorporating some proteins, complex carbs, and fat in your meals will nourish you and the baby and help manage the blood sugar in the body (this is usually one of the potential causes of morning sickness).

  • Boost digestion

Such remedies as peppermint and ginger help to minimize nausea and stomach upsets and hence effective digestion.

Sea-Band Anti-Nausea Ginger Gum For Motion & Morning Sickness
These ginger gums will help you eliminate nausea during pregnancy.
  • Take care of your liver. It is the responsibility of the liver to process hormones and eliminate toxins in the body. However, the liver’s increased activities in the first trimester can make it overwhelmed. Dandelion root and milk thistle teas are perfect for supporting the liver. Lemon water and such fermented foods as raw apple cider vinegar also contribute positively to the health of the liver.
  • Avoid having an empty stomach. Eat some meal immediately you wake up. Include some proteins and complex carbs in the meal. You can also consider having some whole-grain crackers by your bedside. This will help reduce nausea caused by low blood sugar or sluggish bile.
  • Avoid greasy and spicy foods. Bland meals are perfect for any mother struggling with nausea and vomiting. Greasy food is not easy to digest while spicy ones are blamed for higher levels of acidity in the stomach. These two types of foods may contribute to increased nausea.

Frequent urination

The blood count in the body increases with pregnancy. This amount even becomes more during a twin pregnancy than in a singleton. As a result, your kidneys increase their activity on the increased fluid and some of the fluid ends up in the bladder. This is what will make you a frequent guest in the bathroom.

While staying hydrated is a necessity, here is how you can do it:

  • Take your fluids during the early parts of the day and stop one to two hours before going to bed.
  • Avoid diuretics beverages. These include coffee, tea, and seltzer. You can consider hydrating electrolyte drinks such as coconut water or plain water.
  • Make sure that you empty your bladder with each pee by leaning forward. Don’t be in a hurry to leave the toilet, take your time and ensure that you have fully emptied the bladder.


It is common among pregnant mothers with twins to experience extreme exhaustion. This is caused by the sudden increase of progesterone which supports the formation of the two babies and the increase of energy usage in the body.

When you are feeling worn out, the following will be helpful:

  • Drink plenty of water. Dehydration is a major cause of fatigue.
  • Breath deeply during those moments that you find it difficult to fall asleep.
  • Good prenatal care and a healthy diet can boost your energy levels.
  • Have some breaks for naps during the day in case you are working.
  • Sleep early at night, preferably before 9 p.m.
  • Some foods rich in vitamin B such as bee pollen or nutritional yeast flakes do help.
KAL Nutritional Yeast Flakes
These yeast flakes are loaded with tones of nutrients that will keep your energy boosted throughout pregnancy.
  • Take a walk daily for at least twenty minutes. As uncomfortable as it may seem, it will boost your energy in a great way.

9 to 13 weeks symptoms of pregnancy with twins

At this stage, the babies’ fingers, toes, and nails are getting developed. The facial features are getting defined such as the nose, eyes, eyelids, and upper lip. The tooth buds under the gum begin to form. It is also at this stage where the little ones can produce urine which is later discharged into the amniotic sac.

The symptoms at this stage include:

Increased vaginal discharge

Vaginal discharge is normal during pregnancy. However, for a twin pregnancy, the discharge is more than in a singleton pregnancy. This is as a result of the increased amount of blood and hormones in your body when you are carrying the two babies.

This is fine provided that the discharge is clear or white, and odorless. Consult your doctor in case the discharge brings in itchiness, burning sensation, or a bad odor.

Fuller breasts

The fatty tissues and the milk glands present in your breasts become activated in preparation for nourishing the two babies. This will be a time to buy a larger or a more comfortable bra.

HOFISH 3PACK Full Bust Seamless Nursing Maternity Bras
These are the perfect bras for both pregnancy and nursing. They will give you comfort since they help support the extra weight of the breasts.

14 to 17 weeks symptoms of pregnancy with twins

This marks the beginning of the second trimester. At this point the baby bump is visible and it’s easier to tell by its size that you are carrying twins.

The sexual organs of the babies are forming at this stage though the genders can’t be figured out yet till the pregnancy is 18 to 20 weeks old. The ayes balls move behind closed lids, the eyebrows and the eyelashes are formed too. The babies develop tiny movements and sooner they become identifiable.

Early weight gain

In comparison with a singleton mother, a twin mother gains more weight than the former due to the increased volume of blood and growing uterus. A mother carrying twins gains around four or five pounds during her first trimester, this is a bit more compared to the two to four pounds that a mother with a single baby gains within the same period.

Body aches

Swollen legs, backaches, and pain around ligaments are common symptoms among mothers pregnant with twins. This is a result of the extra weight that your body is carrying.

18 to 22 weeks symptoms of pregnancy with twins

At this stage, your babies can suckle their fingers if their hands land on their mouths. The hearing system of the babies starts to develop and the ears start to appear at the sides of the heads. The skin gets covered with vernix and a layer of hair known as lanugo, these two protect the skin of the twins from the amniotic fluid.

Here are several symptoms of pregnancy with twins during this period:

Sleeping difficulties

A comfortable sleep becomes hard due to the growing belly. You can consider using a pillow to support your belly while sleeping on your side. Have a pillow as well in between your knees for better sleep.

Here are some more tips for a good night’s sleep:

  • Avoid caffeine
  • Exercise daily. Research indicates that regular exercise is helpful for better sleep. Exercise during pregnancy ensures that there is a smooth flow of blood in your body and your twins, it helps to reduce some of the discomforts of pregnancy such as backaches, boosts your energy levels, and keeps you healthy emotionally. 

Some of the recommended exercises during pregnancy include walking, swimming, or riding an immobile bicycle. Some other activities like yoga or running are fine but it is important to consult your healthcare provider before you undertake any new exercise.

Although exercises during pregnancy are important for both the mother and the twins, there are several precautions to observe. Below are several dos and don’ts for exercises during pregnancy:


Consult your doctor before being involved in any exercise

Start the exercise gradually. You can take five minutes of exercise during your first day. You can continuously increase the time by the passage of days up to around thirty minutes a day.

Have some breaks in between the exercises to allow for cooling down.

Consider exercising on safe surfaces like a wooden or woolen carpeted floor. If you are having an instructor during the exercises, let them know in advance that you are pregnant.

Stay hydrated by drinking plenty of water.


Avoid forced stretches such as hamstring stretches or trying to reach your toes.

Avoid quick changing of positions, bouncing movements as well as sudden jerking.

Avoid exercises that will strain your belly or your lower-back muscles, such as sit-ups or lifting any of your legs far above the floor.

Avoid carrying out your exercises in an environment that is either hot or humid. Too much heat might lead to the risk of a defective birth especially when the pregnancy is young.

Itchy skin and stretch marks

Stretch marks will result from your skin stretching during pregnancy. On the other hand, hormonal changes that cause the elastic tissue underneath the skin to weaken, causes the skin to become itchy.

Although one cannot prevent the occurrence of stretch marks, drinking plenty of water to keep your skin hydrated and applying a gentle moisturizer can aid in relieving itchiness.

Here are some more recommendations for minimizing the itchiness of skin during pregnancy:

  • Use a soothing lotion (the lotion shouldn’t contain any irritating perfumes), cocoa butter, vitamin E ointment, or purified lanolin balm.
  • Consider treating your skin with an oatmeal bath or using calamine lotion. Avoid applying calamine lotion on the nipples since it might dry them up.
  • Consider a warm bath instead of a hot bath or shower. Hot baths might cause dryness on your skin.
  • Dress up in loose and breathable cotton clothes.
  • Have a humidifier in the house to prevent skin dryness.
  • Though you might feel like scratching the skin to reduce the itchiness, try to avoid it.  Scratching will only increase the itchiness of the skin. Scratching your nipples will make them tender and sensitive which might make it hard to breastfeed when the kids are finally born.

Stretch marks do stay but after delivery, they become less visible and silverish. Be careful not to fall for some misleading claims about oils, lotions, or creams promising to erase or prevent stretch marks. Some mothers opt for a laser treatment but it is important to keep in mind that such is not covered by the insurer since it is considered a cosmetic procedure.


The increased amount of blood flowing in your body can prompt some circulation tendency that can leave you lightheaded. When dizziness strikes, try and minimize your walking pace or lie down sidewise.


Quickening refers to your first time feeling the movements of the babies. You will start feeling these movements around the fifth month of pregnancy. Quickening feels like butterflies roaming inside your tummy or a growling tummy.

Every pregnancy has some uniqueness. So, there is no need to feel scared when you haven’t felt the movements yet according to the time indicated by theories. But you can still chat with your healthcare provider when you feel overly concerned.

23 to 27 weeks symptoms of pregnancy with twins

This stage is characterized by the formation of ridges in the palms of the twin’s hands and on the soles of the little feet. These will become more defined to form both fingerprints and footprints. The hands gain grasping motions and can hold another hand in the womb.

At this point, the babies can respond to sound. They can hear voices and respond by making a move.

At 26 weeks, the lungs of the babies are producing surfactant (this is the substance that inflates the air sacs). This is an important development as it will facilitate the breathing of the twins.

Some of the symptoms during this stage include:

Hot flushes

A majority of women pregnant with twins experience hot flashes at this stage. The hot flashes result from speedier metabolisms and hormonal changes. This causes the body to produce more heat than usual. To keep your body cool, stay hydrated and dress up in comfortable clothes.

High blood pressure

Every time you attend your prenatal clinic, you will have your blood pressure monitored. Your health provider will check if you have preeclampsia which is a high blood pressure disorder that is common in mothers pregnant with twins.[2]

Some of the risk factors leading to preeclampsia include twin pregnancy, first-time pregnancy, first pregnancy from a new father, a difference of two to ten years between pregnancies, previous case preeclampsia during pregnancy, preeclampsia running in the family, a history of kidney disease or high blood pressure, being aged above forty years, diabetes, migraines, lupus, blood clotting disorders, obesity, and IVF pregnancy.

How will you prevent preeclampsia?

Avoiding preeclampsia is often not a possible task, but being in the know of any risk that can expose you to the disorder can help you exercise some precautions.

It is important that before you become pregnant, you identify any risk factors and address them. For example, ensure that your high blood pressure is under control, manage that diabetes or lose the excess weight before getting pregnant. You can consult your doctor on the measures to take if you are already pregnant and have any of the risk factors.

Some health care providers prescribe a low intake of aspirin during the entire term of the pregnancy if the mother is exposed to either of the risk factors.

Look out for these signs and symptoms while pregnant that could be pointing out to preeclampsia: persistent headaches, vision changes, painful shoulders or upper abdomen, sudden gain in weight, nausea, and vomiting, sudden swollen hands or face, difficulties in breathing and decreased amount of urine output.

28 to 32 weeks symptoms of pregnancy with twins

This stage marks the beginning of the third trimester. This period is characterized by aches and pains. This shouldn’t worry you since it’s darkest towards dawn.

Some of the developments in your babies at this point will be opening and closing of their eyes, shedding off the hair covering their body, the functions of the brain get defined and their bones begin to harden.

The following are the symptoms to look out for during this particular time while pregnant with twins:

Pelvic and hip pain

To understand the exact place of pain, it is important that you note that the pelvic bone is located at the bottom of your spine.  On the other hand, hips are extensions of the pelvis bone structure on either side.

Sometimes it is hard for an expectant mother to identify the exact place of pain in this case especially when the pain is radiating. The pains take many forms such as sharp pain, discomfort in the area, or a dull constant ache.

Pelvic pain is common during twin pregnancy. You may feel the pain radiate through the lower back, thighs, or even buttocks. Pelvic pain is usually experienced when you are in motion for example when walking. You could also feel the pain during certain positions such as while lying on the bed.

Pelvic and hip pain is triggered by the weight you are carrying plus the pregnancy hormones. Here is how to relieve or prevent pelvic and hip pain while pregnant: avoid standing for too long, avoid lifting heavy objects, get involved in the proper pregnancy exercises, take a warm shower, place a pillow in between your knees while sleeping, practice good posture, place a heat pack on the painful areas, do Kegel exercises and get yourself a maternity support belt.

AZMED Maternity Belt
This maternity belt will help you by supporting the excess belly weight. Therefore, you will get relief from lower back pains, pelvic pains and hip pains.

Your doctor can also prescribe some pain reliever drugs or recommend some physical exercises to help reduce the pain.

Braxton hicks contractions

Braxton hicks are also referred to as false labor. They are different from actual labor contractions. Just like real labor contractions, Braxton hicks are caused by the tightening of uterine muscles.

Braxton hicks contractions prepare your body for birth through tightening and the relaxation of the uterine muscles. Unlike the actual labor contractions, Braxton hicks have nothing to do with the opening of the cervix. Recognizing the frequency and the period of each contraction will help you determine the kind of labor that you are at.

Braxton hicks can either be mild or more painful. They resemble menstrual cramps and can become more intense towards the close of pregnancy.

Fortunately, several ways can help you minimize the discomfort brought by Braxton hicks contractions when the real labor isn’t realized yet. Movements can help ease these contractions. You can consider changing positions frequently whenever lying down or sitting, or take a short walk whenever possible. Dehydration can also lead to these contractions. So, take plenty of water during the entire pregnancy term and even more towards the delivery of the twins.

Here are some comparisons between Braxton hicks contractions and true labor contractions:

  1. Braxton hicks contractions are neither frequent nor regular. They occur at different intervals, for example, the second contraction may occur after ten minutes, the third contraction after eight minutes, the fourth after thirteen minutes, and so on.

In true labor contractions, the contractions are regular and predictable for example, they can occur after every five minutes. The intervals between contractions will reduce with time.

  • The contractions in Braxton hicks do not intensify. The strength and frequency of true labor contractions keep increasing steadily.
  • Braxton hicks contractions are felt in the front parts of the body. On the other hand, the contractions during true labor begin from the lower back, moves all around to the front and into the groin.
  • Changing positions or activity can help reduce or eliminate Braxton hicks. But this is not the case in true labor. No position or activity can stop true labor.


Hemorrhoids refer to a condition whereby the inner and outer veins of the anus swell and become large. Hemorrhoids are also referred to as piles and have a resemblance to varicose veins when they appear outside the anus.

Hemorrhoids are common in twin pregnancies especially during the final trimester and a few days after delivery. [3]

Some of the symptoms of hemorrhoids during twin pregnancy include bleeding when passing bowels, painful bowel movements, swollen skin around the anus, itchiness, and burning sensations in the area.

Hemorrhoids during twin pregnancy are caused by the increased volume of blood in the body, pressure on the anal veins due to the huge weight in the uterus, constipation, and hormonal changes.

Untreated hemorrhoids can expose you to more pain and severe cases can lead to anemia. While medical attention is important, the following home remedies and lifestyle activities can as well help you reduce hemorrhoids:

  • Use pads or wipes that have the witch hazel.
Witch Hazel Hemorh Pads Size 100s Dickinson'S Hemorrhoid Pads
These pads will give you a relief from hemorrhoidal and vaginal irritation. They will also give the affected area a cool and comfortable sensation.
  • Use soft disposable wipes while using the bathroom.
  • You can soak the area in plain warm water for ten minutes several times each day.
  • Take a bath in Epsom salt and ensure that the water is just warm and not too hot.
  • Place an ice pack on the affected area several times a day.
  • Avoid sitting for too long. Move around. This will ensure that the anus is under no extra pressure.
  • Eat high fiber foods and drink plenty of water to make sure that the stools are always soft.
  • Avoid straining while passing the bowel and don’t sit on the toilet for too long. Don’t hold any bowel, pass it out whenever you feel it’s available.
  • Get involved in Kegel exercises to ensure that you have strong muscles.
  • Consider lying on your sides instead of sitting for too long. This will keep your anus free from pressure.

33 to 36 weeks symptoms of pregnancy with twins

At this point, the vital organs are continuing to develop. The lungs of each baby are getting ready to breathe outside the uterus. The musculoskeletal and circulatory systems are nearly fully developed. The twins are gaining weight though they are smaller than singletons.

Here are the symptoms of pregnancy at this stage:

Swollen or painful legs

This results from fluid retention in the legs and feet. As much as possible, keep your feet elevated. Sometimes severe swelling and pain in the legs will point to preeclampsia (a high blood pressure disorder). Consult your doctor whenever you are concerned about swollen legs.


You will feel drained or extra tired even when you have not performed a heavy task. Carrying the twins is work by itself. You can consider taking some naps during the day whenever possible. You can also participate in some light exercises to boost your energy.

Deep vein thrombosis

This condition is witnessed in pregnancies with twins though it is not common. It is at times seen in pregnant mothers who are under bed rest. This condition is characterized by swelling in one leg which could be accompanied by pain, warmth, or redness in the calf area. Consult your doctor immediately once you notice those symptoms.[4]

37 to 40 weeks symptoms of pregnancy with twins

The babies are now head down ready for a vaginal delivery. There are those cases where it’s only one baby that had their head facing down words or the two babies have their feet downwards. Your doctor will continuously be monitoring the positions of the babies.

Most of the baby’s vital organs are well developed at this point and ready to function outside the womb.

According to research published by Frederic Michas in 2019 in the USA, the state of Connecticut was leading in the average twin births rate. According to the research, 39.7 out of the 1000 births were twin births between the years 2016-2018.

Some of the symptoms of pregnancy with twins during this stage include:


Here your partner might tell you how you have turned out to be noisy while asleep. You can consider wearing nasal stripes or have a humidifier in place at night.

Breathe Right Nasal Strips to Stop Snoring
These nasal stripes will give you relief from nasal congestion whenever you are asleep. Their calming scent will enable you breath freely and give you a better sleep.

Moving difficulties

Moving around can become challenging due to the huge weight you are carrying. Relax and don’t be in a hurry while in motion.


Can you miscarry one twin and carry the other to the full term?

This depends on the type of twins. For the identical twins, miscarrying one leads to the death of the other. When one dies, their decaying blood flows into the other causing another death. For the fraternal twins, there are survival chances for the remaining twin after one has been miscarried.

Is it possible for a pregnant mother to have two fathers responsible for her twin pregnancy?

Yes, this is possible, especially with fraternal twins. This will happen if the woman had released two eggs during her ovulation and the two eggs become fertilized by a sperm each from a different father. This can happen if the lady is a sex worker or was gang-raped.

Why is it risky to fly during twin pregnancy?

This is as a result of your increased risks of getting preterm labor while pregnant with twins. The various changes in atmospheric pressure could expose you to the risk of preterm labor. However, flying when the twin pregnancy is less than twenty-eight weeks old could be fine.

Final thoughts

Discovering that you are pregnant with twins can bring with it a mix of emotions ranging from excitement to panic. When consulting your health worker, ensure that you not only discuss the symptoms but also any questions that you have, the risks involved, and even the anxieties involved. Here are some great articles that will ensure that you have an amazing twin pregnancy journey: Everything You Need to Know to Have a Healthy Twin Pregnancy, Twins 101 and What to Do When You're Having Two.

[1] Källén, Bengt. “Hyperemesis during pregnancy and delivery outcome: a registry study.” European Journal of Obstetrics & Gynecology and Reproductive Biology 26.4 (1987): 291-302.

[2] Bdolah, Yuval, et al. “Twin pregnancy and the risk of preeclampsia: bigger placenta or relative ischemia?.” American journal of obstetrics and gynecology 198.4 (2008): 428-e1.

[3] Mohamed, Donia Ibrahim, Inass Kassem Ali Kassem, and Amera Bekhatroh Rashed. “Effect of Conservative Nursing Management on Symptoms of Hemorrhoids during Late Pregnancy.”

[4] Fiengo, Leslie, et al. “Postpartum deep vein thrombosis and pulmonary embolism in twin pregnancy: undertaking of clinical symptoms leading to massive complications.” Thrombosis journal 11.1 (2013): 1-4.

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Diana Lucas

Diana Lucas

Hi, Diana here. Welcome to my blog and hope you like my sharing. I am a mother of 2 boys, 3 years old and a 1 year old. I dedicate my career in child development research and I focus on parenting tips, positive parenting, educational toys for my babies. Your time here means a lot to me! Diana A. Lucas