Preparing To The Best of Your Abilities: Nutrition & Diet for Multiples Pregnancy

When you are pregnant, your body has extra nutritional needs. Even more so when you are carrying multiples, such as twins or triplets.

- What You Can Start While Trying To Conceive - 

• Folic Acid

According to Web Md's article, 11 Things You Didn't Know About Twin Pregnancies, "Women with twins may need more folic acid to help prevent birth defects. Manju Monga, MD, the Berel Held Professor and the division director of maternal-fetal medicine at the University of Texas Health Sciences Center in Houston recommends 1 mg (1000 mcg) per day of folic acid for mothers expecting twins and 0.4 mg (800 mcg) per day of folic for a mother expecting a single baby" (Mann). 

Prenatal vitamins that have 1 mg  (1000 mcg) are usually prescriptions and prenatal vitamins that have 0.4 mg (800 mcg) are over the counter. You can find a few over the counter supplements online that have 1 mg of folic acid or folate (links included), such as Thorne Research  5-MTHF has 1 mg folate. As far as prenatal vitamins go, there are the Promise Prenatal vitamins that come in 3 stages. Stage 1 is designed for before you become pregnant through your first trimester of pregnancy and has 990 mcg of folic acid. To see this prenatal vitamin, click here.

• Water

It is said the book When You're Expecting Twins, Triplets or Quads by Dr. Barabara Luke, the recommendation is a gallon of water a day for a multiples pregnancy (Howard).  Even in my singleton pregnancies, I've been recommended to drink a gallon of water. You can certainly start practicing getting a gallon of water a day, especially if you're someone that tends to get less than 8 cups of water a day. 

• Iron

In the article Twins & Multiples Births: Potential Risks, "The majority of women pregnant with multiples eventually develop iron deficiency anemia. The risk of developing this increases with each additional baby a woman is pregnant with, especially if the woman had low or borderline reserves before becoming pregnant" (Twins & Multiple Births: Potential Risks). I have some experience with this. Before trying to conceive my third child, I had gotten some blood work done to check my thyroid. My lab results revealed my iron and thyroid levels fell on the low end of the normal range. Throughout my third singleton pregnancy, I took a prenatal vitamin with iron. When my iron levels were checked at 33 weeks during my 2nd trimester, it was 11.6. Four months later, when I requested it to be checked again at 37 weeks in my third trimester, it had dropped to 9.6. My obstetrician recommended an iron supplement and stool softener. My midwife said they like to see iron at least at a 10. Before trying to conceive or while you are if you have already started, get your iron levels checked. If they are below the normal range, your health care provider may encourage you to take an iron supplement. Likewise, if they are on the lower end of the normal range, it may be beneficial to take an iron supplement with your prenatal to ensure your iron is higher for when you become pregnant.

• Vitamin C  & E

Vitamins, such as Vitamin C and E are said to help reduce the risk of preeclampsia. According to www.drbarbaraluke.com, "The ideal dose is 1000 mg of Vitamin C and 400 IU of Vitamin E. For better absorption of Vitamin C split the dose in half, taking 500 mg in the morning and at night" (Luke). You can take these supplements in addition to your prenatal vitamins if the dose in your prenatal vitamins is not enough.

• Vitamin D

In the article, High Doses of Vitamin D May Cut Pregnancy Risks, it says "A study shows 4,000 IU of Vitamin D (10x the recommended amount by various health groups) may reduce the risks of complications, such as gestational diabetes, preterm birth, pregnancy-related high blood pressure and preeclampsia. Women who took this amount in their second and third trimester of pregnancy according to the study showed no evidence of harm, but half the rate of pregnancy complications compared to women who took 400 IU of Vitamin D every day" (Boyles). Before trying to conceive or while you are if you have already started, get your Vitamin D levels checked. Vitamin D deficiency is common among all races, especially among those with darker skin. Darker skin has a harder time absorbing sunlight. If your Vitamin D levels are below the normal range, your health care provider may encourage you to take a Vitamin D supplement in addition to your prenatal vitamin.

• Calcium & Magnesium

Minerals, such as Calcium and Magnesium also, help during pregnancy. According to www.drbarbaraluke.com, "Calcium helps reduce the risk of developing preeclampsia and Magnesium help prevent premature labor by minimizing uterine contractions" (Luke). You can take these supplements in addition to your prenatal vitamins if the dose in your prenatal vitamins is not enough.

- What You Need To Know For A Multiples Pregnancy - 

• Calories

I found this interesting article from Twin Possible called, Eating For 2, 3, Or More!  The Real Deal When It Comes To Calories & Weight Gain During Singleton & Multiple Pregnancies, "It says in a singleton pregnancy, a mom needs an extra 300 calories to grow a healthy baby. However, in a twin pregnancy, an expecting mother needs an extra 600 calories. In a triplet, an extra 900 and for quads, 1,200 calories" (Twin Possible). In this great blog post called Triplet Pregnancy vs Singleton Pregnancy: Nutrition, Excercise and Weight Gain written by a mother of triplets, the author writes that in a book she read called When You're Expecting Twins, Triplets or Quads by Dr. Barabara Luke, that it says a triplet pregnancy requires 4,000 calories a day. This mother also says from her personal experiences, the first 20 weeks, that she had to eat 700-800 calories within a few hours of waking up to prevent feeling nausea/morning sickness and she had to eat every 2-3 hours (Howard).

• Weight

You May Have Mixed Emotions About Your Body & Weight

One thing that probably hasn't been considered is that with a multiples pregnancy, you will gain more than you would in as singleton pregnancy. Referring back to this great blog post called Triplet Pregnancy vs Singleton Pregnancy: Nutrition, Excercise, and Weight Gain written by a mother of triplets, the author addresses what many other mothers who have had a multiples pregnancy maybe have experienced and are able to relate to, that she had a hard time when she passed how much her husband weighed and even thinking about how much weight is recommended for a multiples pregnancy and wrapping her head around those high numbers (Howard). In a singleton pregnancy, doctors often recommend 25-35 lbs for a woman that is in her normal and healthy weight range. And for some women even pregnant, they will still weigh less than their spouse or significant other. One thing I do know is if you ask a pregnant woman how she feels about her body or weight gain during her pregnancy, you will get a variety of answers, ranging from those who are overall happy and fine to those who are uncomfortable and it is somewhat upsetting. 

Correlations Between Weight Gain & Baby's Birth Weight

Something else to consider is with a multiples pregnancy there is a correlation between weight gain and the size of the babies when they are born. In a twin pregnancy, the expecting mom should gain 35-45 pounds and in a triplet pregnancy, 50-60 pounds (Twin Possible).

However, in a singleton pregnancy, how much weight you gain does not always indicate how small or large your baby will be. This is true for me. My first pregnancy, I gained 41 pounds and carried my baby to 40 weeks and 2 days. She was my medicated birth with an epidural, so I did have to receive an IV before being able to get the epidural. I believe the IV created water weight, because she was 8 lbs and 2 oz at birth, but lost 12% of her body weight within the first few days. My second pregnancy I gained 31 lbs and I carried my second to 39 weeks and 2 days. My second baby was an unmedicated birth and he weighed 8 lbs and 2 oz at birth, never lost any body weight. My third baby was an unmedicated birth, he weighed 8 lbs and 8 oz at birth and lost a little weight but bounced back quickly.

- Sources - 

1. Boyles, Salynn. "High Doses of Vitamin D May Cut Pregnancy Risks." WebMD. WebMD, 4 May 2010. Web. 01 Mar. 2016. <http://www.webmd.com/baby/news/20100504/high-doses-of-vitamin-d-may-cut-pregnancy-risk>.

2. Howard, Kendra. "Triplet Pregnancy vs Singleton Pregnancy: Nutrition, Exercise, and Weight Gain." Howard Trio. Blog Spot, 1 June 2013. Web. 11 Feb. 2016. <http://howardtrio.blogspot.com/2013/06/triplet-pregnancy-vs-singleton.html>.

3. Luke, Dr. Barbara. "Vitamin and Mineral Supplements: Your Nutrition Insurance Policy." Dr. Barbara Luke: Foods, Facts, Fashions for Women Expecting Multiples. Dr. Barbara Luke, 2015. Web. 15 Feb. 2016. <https://www.drbarbaraluke.com/vitamin.aspx>.

4. Mann, Denise, and Louise Chang, MD. "11 Things You Didn't Know About Twin Pregnancies." WebMD. WebMD, 2015. Web. 18 Dec. 2015. <http://www.webmd.com/baby/features/11-things-you-didnt-know-about-twin-pregnancies>. 

5. "Twins & Multiple Births: Potential Risks." Twins UK. Twins International LTD, 2008. Web. 12 Feb. 2016. <http://www.twinsuk.co.uk/twinstips/4/16/twin-pregnancy-&-multiple-births/twins-&-multiple-births-:-potential-risks/>.

6. Twin Possible. "Eating For 2, 3, Or More! The Real Deal When It Comes To Calories & Weight Gain During Singleton & Multiple Pregnancies." Expecting Twins Learn How To Raise Twins at Twinpossible.com. N.p., 29 Mar. 2011. Web. 11 Feb. 2016. <http://twinpossible.com/eating-for-2-3-or-more-the-real-deal-when-it-comes-to-calories-weight-gain-during-singleton-multiple-pregnancies>.

Last Edited:  June 28, 2017