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Nutrition in Twin Pregnancy

If you are carrying twins you will need to increase the amount of nutrients and calories you eat to meet your own nutritional needs and the high demands of your growing babies. The requirements for some nutrients increase each trimester and may not be met by diet alone.  Additional iron, folate, calcium, magnesium, and zinc supplementation has been  recommended beyond the usual prenatal vitamin (Table 1).

Table1.  Recommendations for Nutritional Supplementation in Twin Pregnancies
  First trimester   Second and third trimesters
  • One multivitamin tablet with iron (30 mg) daily.
    If not provided by their diet or multivitamin, supplement additional:
    • Calcium 1,500 mg
    • Magnesium 400 mg
    • Zinc 15 mg
    • DHA/EPA 300-500 mg
    • Folic acid 1 mg
    • Vitamin D 1,000 IU
    • Vitamin C 500 - 1,000  mg
    • Vitamin E 400 IU
  • Two multivitamin tablets with iron (30 mg) daily.
    If not provided by their diet or multivitamin, supplement additional:
    • Calcium 2,500 mg
    • Magnesium 800 mg
    • Zinc 30 mg
    • DHA/EPA 300-500 mg
    • Folic acid 1 mg
    • Vitamin D 1,000 IU
    • Vitamin C 500 - 1,000  mg
    • Vitamin E 400 IU

20% of the calories in your diet should come from protein, 40% from carbohydrates, and 40% from fat. You should eat  three main meals with three smaller snacks in between the main meals. Eat a wide variety of foods such as almonds , apples, avocado, beans, blue berries, broccoli, Brussels sprouts, eggs, flaxseed, guava, lentils,  oats, red peppers, spinach, sweet potatoes, tofu, or tomatoes just to name a few.  Try to eat at least two meals (12 oz total) every week  of low-mercury–containing fish (eg, shrimp, canned light tuna, salmon, pollock, and catfish). Choose low or no fat dairy products, or try an alternative such as almond milk .

Recommendations for weight gain and calorie intake during your twin pregnancy are given below and are based on your weight before pregnancy. If you started out at a normal weight before pregnancy and you gain a little more weight than the recommended weight you should still be O.K. One study found that  women with twin pregnancies and a normal weight before pregnancy, excessive weight gain was associated with  larger birth weights and did not appear to increase the risk of development of gestational hypertension, pre-eclampsia, or gestational diabetes.

Table 2. Suggested Weight Gain and Calorie Intake by Body Mass Index (BMI) in Twin Pregnancies

Prepregnancy BMI

Recommended Weight  Gain

Daily Calories (kcal) Protein  (grams) Carbohydrate (grams) Fat
(grams)
18.5 or less Underweight 17 - 25 kg
37 - 54 pounds
4,000 200 400 178
18.5 to 24.9
Normal weight
17 - 25 kg
37 - 54 pounds
3.000 - 3500 175 350 156
25 to 29.9 Overweight 14 - 23 kg
31 - 50 pounds
3250 163 325 144
30 or more
Obese
11 - 19 kg
25 - 42 pounds
2700 - 3000 150 300 133

1 gram protein = 4 Calories, 1 gram carbohydrate = 4 Calories , 1 gram fat = 9 calories).

See Also 


REFERENCE

1. Goodnight W, et al. Optimal nutrition for improved twin pregnancy outcome. Obstet Gynecol. 2009  PMID: 20168116
2. Luke B. Improving multiple pregnancy outcomes with nutritional interventions. Clin Obstet Gynecol 2004;47:146–62.
3. Rasmussen KM ed et al. Weight Gain During Pregnancy: Reexamining the Guidelines Institute of Medicine; National Research Council 2009. p 252, 254 http://www.nap.edu/catalog/12584.html
4. Fox NS, et al Excessive weight gain in term twin pregnancies: examining the 2009 institute of medicine definitions.Obstet Gynecol. 2011 Nov;118(5):1000-4.PMID: 22015867

Reviewed by Mark Curran, M.D. ,F.A.C.O.G

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