Twin Pregnancy: Signs, Types & Risks

Some women suspect that they are carrying twins from the beginning of their pregnancy whereas some women get completely surprised when they come to know about twin pregnancy after their first ultrasound scan report. In this article, we will discuss everything about twin pregnancy, the symptoms of twins in pregnancy, the difference between single and twin pregnancy symptoms, the risks involved and much more.

What is a twin pregnancy?

Twin pregnancy is a rare occurrence which happens when there are two foetuses in the uterus at the same time. To accommodate two babies in your womb, the baby bump will appear bigger than normal and you might also experience more severe twin pregnancy symptoms.

What are the possibilities of getting twins?

The possibility of conceiving twins naturally is low since it is a type of multiple pregnancy. Twins pregnancy occurs in 1 out of every 250 pregnancies approximately.

What are the symptoms of twin pregnancy?

From the beginning of your pregnancy, your body undergoes massive changes and produces different types of hormones. If you want to know the difference between single and twin pregnancy symptoms, then here are some symptoms of twins in pregnancy:

1. Elevated hCG levels

The presence of human chorionic gonadotropin hormone is generally high in your blood and urine sample from the beginning of your pregnancy. The higher levels of hCG in the first two weeks also lead to the development of the zygote and implantation. Undoubtedly it is one of the symptoms of twins in pregnancy. However, for confirmation, the doctor will recommend you undergo a transvaginal ultrasound scan by the 8th week of your pregnancy.

2. Morning sickness in extreme

Some women complain of experiencing severe morning sickness at any time of the day while expecting a twin. From the beginning of the first trimester, many women feel nauseated and their vomiting is also in excess because of multifetal gestation. The morning sickness slowly fades at the end of their first trimester.

3. Mother’s intuition

Some women are asymptomatic at the beginning or might experience normal symptoms of pregnancy which include cramping, nausea, breast tenderness, fatigue, and vomiting. These signs and symptoms exaggerate as the journey of twin pregnancy proceeds and sometimes many women instinctively guess that they are expecting twins. These intuition-based feelings are quite common because some women also get dreams of having twins. You must not feel ashamed to speak to the doctor about your gut feelings.

4. Excess weight gain

Gaining weight in pregnancy is obvious but in the case of twin pregnancy or multiple pregnancy, women tend to gain more weight from the beginning. The amount of weight gain also depends on certain factors like your body type, height, and if any chronic disease persists.

5. Extreme fatigue

Feeling exhausted, lethargic, and drowsy are some of the common complaints that are made by almost every pregnant woman but if you are carrying twins these symptoms get exaggerated. If you are feeling more tired as compared to your last pregnancy then certainly it is one of the important signs that will give you a hint of your twins pregnancy.

When you are carrying twins, your body will automatically demand more food and that increases your appetite. To accommodate two babies in your womb later on the baby bump will appear bigger than normal. You might also experience severe mood swings because of the excess production of hormones during pregnancy. Shortness of breath and cramping are also some of the common signs but if in excess you must have a word with your doctor.

What signs indicate a twin pregnancy?

Here are the early signs and symptoms of twins in pregnancy that you must look out for:

• Early foetal movement

• Foetal movements in more than one area

• Fundal height greater than gestational age

• Rapid weight gain

• High hCG levels

• Hearing more than one heartbeat during the foetal Doppler test

What is the procedure for confirming a twin pregnancy?

The twin pregnancy is confirmed by your gynecologist who makes sure you undergo a clinical evaluation, an ultrasound scan, a doppler heartbeat count, and an MRI (Magnetic Resonance Imaging).

How is the belly of a pregnant twin different from the tummy of a singleton?

Compared to the belly of a singleton pregnancy, your baby bump will begin to show early on during a twin pregnancy. Because of your fast-growing baby bump and rapid weight gain, you may outgrow your clothes quickly. You may need maternity clothes within a short period after finding out you’re carrying twins. Women tend to gain around 22 kg weight during a twin pregnancy compared to 13 kg for a singleton baby.

Different types of twins

Twins can either be fraternal or identical.

1. Fraternal Twins

Fraternal twins develop when two sperm fertilise two different eggs in one cycle. This leads to a separate placenta for each baby. The DNA of fraternal twins is similar to that of siblings of different ages. The twins may or may not have the same sex.

2. Identical Twins

Identical twins occur when a single embryo from one egg and one sperm divides into two embryos. The identical twins may or may not share the same placenta. Identical twins always share the same sex.

With identical twins, there is an extremely rare chance of having conjoined twins i.e., when the embryo doesn’t fully divide. The babies’ bodies are joined together and may share some vital organs. Chest or abdomen are the most common points of fusion because of which the twins may share a liver or heart.

How do I become pregnant with twins?

Certain circumstances can increase your chances of twin pregnancy or multiple pregnancies and they are as follows:

1. Family history

If the pregnant woman has a family history of fraternal twins, then the chances of expecting twins are usually higher.

2. Fertility treatments

If the woman has undergone fertility treatment like IVF (In vitro fertilization), then her chances of having twins increase.

3. Maternal age

If the age of the mother is over 35 years old, she is likely to release multiple eggs during ovulation.

4. Obesity

Women with a Body Mass Index higher than 25 or those who are obese are more likely to conceive twins.

5. Personal history

If you had twins or experienced hormonal fluctuations during your previous pregnancy, then you’re more likely to have a twin pregnancy again.

How can fertility treatments increase the chances of twins?

When you undergo a fertility treatment such as In Vitro Fertilisation (IVF), you’re given fertility drugs which cause you to release more than one egg per cycle. Or you may have more than one embryo implanted during the IVF. Additionally, it’s also possible for the implanted embryo to split in early pregnancy after an IVF.

How is prenatal care different for twin pregnancies?

With a twin pregnancy, both the expecting mother and her twins face a higher risk of pregnancy and birth complications. As a result, prenatal checkups are required more frequently with twins pregnancy to detect issues at the earliest. Because the risk of complications is higher during a twin pregnancy, many expecting mothers receive prenatal care from obstetricians specialising in high-risk pregnancies.

Types of problems related to twin pregnancies?

Some of the complications that arise during a twin pregnancy include:

• Anemia

• Congenital defects like spina bifida

• Gestational diabetes

• Preeclampsia

• Low or too much amniotic fluid

• Placental abruption

• Twin-to-twin transfusion syndrome

• Premature labor

If the twins are delivered prematurely, they may be at a risk of additional complications such as:

• Brain bleeds

• Difficulty breathing from underdeveloped lungs

• Difficulty staying warm

• Feeding problems

• Low birth weight

When are twins born?

The full gestational period of a normal pregnancy is 40 weeks. However, most twin pregnancies run the risk of going into preterm labor. As a result, the twins may be born at approximately 36 weeks. The average range of delivery for a twin pregnancy is 32-38 weeks.

Tips to Follow When Carrying Twins

Here are a few tips that you must keep in mind if you are carrying twins or multiples:

• Your doctor might warn you that you are having a high-risk pregnancy. You must schedule your prenatal appointments, tests, and ultrasound scans in advance.

• Eat a nutritionally balanced diet that includes whole wheat, a variety of fluids, seasonal fruits, colorful vegetables, and some healthy snacks.

• Do not hesitate or feel ashamed to ask for help from your friends and family during pregnancy. You must not exert your body and take plenty of rest.

• Practicing prenatal yoga under the supervision of a certified trainer is advisable during a twin pregnancy.

References

1. Gill P, Lende MN, Van Hook JW. (June,2022). Twin Births. NCBI