Objective: The aim of this study was to establish early pregnancy risk indicators for spontaneous twin very preterm birth. Methods: We conducted a retrospective observational population-based study. Twenty-one potential early pregnancy risk factors were analyzed using multivariable logistic regression to determine which of them was independently associated with spontaneous twin very preterm birth. Results: Of 1815 spontaneous twin births 15.3% (277) occurred before 32 weeks. Previous preterm delivery (aOR 3.73; 95% CI, 2.52–5.52), nulliparity (aOR 2.94; 95% CI, 2.09–4.14), body mass index <18.5 (aOR 1.86; 95% CI, 1.12–3.10), body mass index ≥30 (aOR 1.87; 95% CI, 1.21–2.89), hysteroscopic metroplasty (aOR 1.63; 1.07–2.49), conization (aOR 2.05; 95% CI, 1.07–3.94) and monochorionicity (aOR 1.83; 95% CI, 1.28–2.63) were significantly associated with twin very preterm birth. Conclusions: Pending verification in other populations, twin pregnancies at significant risk for spontaneous very preterm birth can be identified in early pregnancy using several risk indicators.