Is there such a thing as being twice as pregnant? As you begin to experience pregnancy symptoms, you may wonder whether having stronger symptoms means something — are there signs you’re having twins? Is it normal to be this exhausted and this nauseous, or could it mean something more?

While the only definitive way to know whether you’re pregnant with twins is an ultrasound, some symptoms may suggest that a little something extra is happening on the inside.

As soon as pregnancy begins, your body begins to produce hormones and undergo physical changes. These changes may be the first sign of pregnancy. What’s more, some of these signs may be slightly different when you’re expecting more than one baby.

Many people who experience twin pregnancy report that they had a sense or feeling that they were expecting multiples, even before they knew for sure. On the other hand, for many people, the news comes as a complete surprise.

The following symptoms are commonly reported as signs that you may be pregnant with twins, from the earliest weeks of pregnancy.

It’s not entirely clear why some people experience morning sickness, but for many pregnant people, it can begin as early as the 4th week of pregnancy, which is right around the time you miss your period.

Increases in the pregnancy hormone human chorionic gonadotropin (hGH) may contribute to feeling nausea at any time of the day. (That’s right, morning sickness doesn’t only happen in the morning.)

Some people pregnant with multiple babies report experiencing elevated levels of morning sickness, or morning sickness that lasts longer into their pregnancy. It can be difficult to establish a baseline for morning sickness, as it can vary from person to person, as well as from pregnancy to pregnancy.

Experiencing nausea and vomiting that lasts beyond the 14th week of pregnancy could indicate that you’re pregnant with multiple babies.

Unfortunately, experiencing severe or prolonged morning sickness can also be in indicator of hyperemesis gravidarum. If you’re vomiting several times a day, experiencing nausea all day, or losing weight, it’s a good idea to speak with your OB-GYN.

Fatigue is also a very early pregnancy sign. In the first weeks, and sometimes even before your missed period at 4 weeks, you may begin to feel exhausted. Elevated hormone levels, along with possible issues like sleep interruptions and increased urination, may disrupt your ability to get your usual amount of rest.

Again, there’s no way to know for sure whether the fatigue that’s setting in means that you’re expecting one baby or more. If you’re feeling extra tired, do what you can to get enough rest, including moving your bedtime earlier, taking naps when possible, and creating a restful sleep environment.

Human chorionic gonadotropin (hCG) is a hormone produced by the body during pregnancy. Home pregnancy tests detect this hormone in urine to give you a positive test result. While home pregnancy tests can’t tell you the specific level of hCG in your body, blood tests can.

If you’re undergoing certain fertility treatments, you may have blood drawn to check on your hCG numbers. Your OB will establish a baseline, then watch to see whether the numbers double as expected. A 2018 study showed that those pregnant with multiples may have a higher than expected hCG count.

Your baby’s heartbeat may be heard as early as 8 to 10 weeks using a fetal doppler. If your OB-GYN thinks they hear a second heartbeat, they’ll likely suggest scheduling an ultrasound to get a better picture of what’s happening.

Measuring ahead isn’t an early sign of twins, as it’s unlikely that your provider will measure your belly until after 20 weeks of pregnancy. At this stage, it’s likely you have an ultrasound scheduled if you haven’t already had one.

Some people report showing earlier when pregnant with twins, but the point at which your pregnancy begins to show varies depending on the person and the pregnancy. Many people will show earlier during their second pregnancy.

Since most parents don’t report feeling movement until around 18 weeks, this isn’t an early sign either. Your baby moves in the womb from the beginning, but it’s unlikely you’ll feel anything until your second trimester.

Of course, having two or more babies can mean that you’ll feel movement slightly earlier than you would have with only one baby, but this is very unlikely to happen before your second trimester.

This is another sign that may not come into play until farther along in your pregnancy. During the first trimester of your pregnancy, weight gain is likely to be relatively low.

The standard recommendation is a gain of 1 to 4 pounds over the first 12 weeks. Weight gain happens more rapidly in the second trimester, regardless of whether you’re expecting a single baby or more.

If you are gaining weight faster during your first trimester, you should speak with your OB-GYN about possible causes or concerns.

The Centers for Disease Control and Prevention (CDC) notes the following weight gain guidelines, which are based on pre-pregnancy body mass index (BMI), for women pregnant with twins:

  • BMI less than 18.5: 50–62 lbs.
  • BMI 18.5–24.9: 37–54 lbs.
  • BMI 25–29.9: 31–50 lbs.
  • BMI greater or equal to 30: 25–42 lbs.

However, if you’re experiencing morning sickness or other issues, you may not gain (and even lose) weight in the first trimester. Again, if you’re concerned about your weight gain, you may want to speak with your doctor.

Although the factors above may be signs of a twin pregnancy, the only sure way to know you’re pregnant with more than one baby is through an ultrasound.

Some doctors schedule an early ultrasound, around 6 to 10 weeks, to confirm the pregnancy or check for issues. If you don’t have an early ultrasound, know that you’ll be scheduled for an anatomy scan around 18 to 22 weeks.

Once your doctor is able to see the sonogram images, you’ll know exactly how many babies you’re carrying.

According to the CDC, the rate of twins was 32.6 twins per 1,000 total births in 2018. Many different things contribute to the number of twins born each year. Factors like age, genetics, and fertility treatments can increase your likelihood of becoming pregnant with twins.

While a pregnancy with twins or more is exciting, it comes with some risks. Focusing on your health and seeking prenatal care is especially important during a multiple pregnancy.

Early pregnancy symptoms can’t tell you for sure whether you’re pregnant with two or more babies, but regular prenatal appointments and testing can. Always discuss your concerns with your OB-GYN, and take good care of yourself — no matter how many babies you’re carrying.