Pregnant With Twins Or Multiples

Got more than one baby on the way? Your pregnancy is bound to be different from a single-baby pregnancy. Here are the answers to your most pressing questions about expecting twins or multiples.

How Did I Become Pregnant With Multiples?

In vitro fertilization (IVF) and some fertility drugs can increase the chance of having multiple babies, and so can a family history of twins.

Multiples or twins can either be identical or fraternal, and, in a higher-order multiple pregnancy, you can have both identical and fraternal babies in the same pregnancy. Identical babies are conceived when one fertilized egg splits into two or more embryos. In case of fraternal babies, two eggs are fertilized simultaneously, resulting in more than one embryo.

What Are the Symptoms of a Twin or Multiple Pregnancy?

When you’re pregnant with twins or multiples, you may notice that’s something’s different early in your pregnancy. Signs you’re pregnant with two or more babies usually include:

  • Severe morning sickness, due to higher quantities of the hCG hormone being produced in the body

  • Rapid weight gain during the first trimester

  • A bump that may appear larger or show earlier, as moms expecting twins will usually have a larger uterus than moms pregnant with only one baby

  • More breast tenderness than women pregnant with singles.

How and When Can a Multiple Pregnancy Be Confirmed?

Your healthcare provider may suspect you’re pregnant with twins or multiples if your uterus is larger than normal and if there seems to be more than one fetal heartbeat. An ultrasound exam − which uses sound waves to create visual images of your babies − can usually detect multiples by 12 weeks.

What Types of Twin Pregnancy Are There?

There are two types of twin pregnancies:

  • Identical twin pregnancy. When you have identical twins, this means you had one fertilized egg that split into two very early on in your pregnancy. They will be the same sex and look very much alike with the same eye colour, hair colour, and blood type.

  • Fraternal twin pregnancy. This is the most common twin type. Fraternal twins can be thought of as two separate pregnancies happening at the same time while sharing the same womb. When two eggs are fertilized, these can develop into fraternal twins. This means genetically your babies are related to each other the same way siblings are related. You can have same sex twins, or a boy and a girl. You can see how fraternal twins are different from identical twins in the image below.

How Is a Multiple Pregnancy Different?

You may feel fine, but carrying twins or other multiples is automatically a high-risk pregnancy. You'll likely be referred to a specialist and have more prenatal visits, blood tests, and ultrasounds than you would with a singleton pregnancy.

For more information, check out our guide to multiple pregnancies.

What Are Twin Pregnancy Risks?

  • Premature delivery. The risk of premature delivery is higher in a multiple pregnancy. Calculate your approximate due date, but keep in mind your little gang might arrive early, possibly before 36 weeks. In this case, your babies might need special assistance with breathing or sucking for a while.

  • Low birth weight. Each baby tends to be smaller in a multiple pregnancy, weighing on average 5.1 pounds (2.3 kilograms) at the time of birth.

  • One of the babies can get tangled in the umbilical cord. In very rare cases, some twin babies can share the same amniotic sac. This can be risky if one of the babies becomes tangled up in one of the umbilical cords. Should you have this kind of pregnancy, your healthcare provider will monitor you more frequently, and it is likely you will have to give birth via a c-section.

  • Twin-twin transfusion syndrome. Another risk is twin-twin transfusion syndrome (TTTS), where one baby gets too much blood flow, and the other baby doesn't get enough. Your doctor will discuss with you how to overcome these challenges.

How Much Weight Should I Gain in a Twin Pregnancy?

When you’re pregnant with twins, it’s natural you’ll gain more weight. It’s important that you gain the weight gradually and steadily to support your babies’ health. Gaining weight while pregnant depends on your height and starting weight before you’re pregnant. In general, if you are healthy and had a normal weight before becoming pregnant, the recommended weight gain with twins ranges from 37 to 54 pounds, or 16.7 to 24.5 kilograms. This may require an additional 600 calories a day (300 for each baby), on top of the recommended 2000 daily calories in the second half of your pregnancy, depending on your activity level. Ideally you would gain about a pound a week in the first half of your pregnancy, and then a little more than one pound a week in the second half. Read more about gaining weight healthily during pregnancy.

How Can I Prepare for Twins?

  • Find the right healthcare provider. First up, it's important to choose healthcare providers who are experienced with twins. They'll be able to answer the questions that are relevant to your pregnancy and offer the appropriate advice and care.

  • Take care of yourself. As it is with any pregnancy, rest is important if you're pregnant with twins, and, especially during the second trimester, some gentle exercise may help you sleep better. Following a good pregnancy diet helps ensure that you and your little ones are getting all the nutrients needed for healthy growth. Also, make sure you go to all your prenatal visits.

  • Make sure you get ready with plenty of time to spare. Consider taking early maternity leave, if you can. Many twin moms-to-be do this because their babies may arrive as early as 35 weeks, and this gives them more time to get prepared at home. This can mean stocking up on sets of everything from car seats to cribs, clothes and diapers; babyproofing your home; and getting your hospital bags packed nice and early, at around 34 weeks.

Is It Normal to Feel Anxious About a Twin Pregnancy?

It’s natural to feel apprehensive about expecting two or more babies. After all, you’ll have to be prepared, focused, and physically fit to take care of more than one newborn at once. But, although multiple babies will mean more of everything, remember, your growing family will be a whole lot of fun, too, with more children bringing love into your life.

Try to seek out support networks, speak to your doctor, and find other moms of twins for guidance. Be sure to take a childbirth class, too; there are some that are designed specifically for parents of multiples.


Multiple pregnancies can happen naturally and seemingly out of the blue, but there are a few factors that can increase the likelihood of conceiving two or more babies. In addition to a family history of multiples, women over the age of 35 can be more likely to become pregnant with multiples than younger women. Fertility drugs including clomiphene citrate and gonadotropins can also increase the chances of a multiple pregnancy.