Twin pregnancy diet and weight gain
Meeting nutritional demands for a multiple pregnancy is no walk in the park, but it does not mean you need to eat for 3 (or more!). However, it does require some careful planning to ensure you gain the right amount of weight for you and your babies during your pregnancy.
Twin and higher order pregnancies are at an increased risk of pre-term birth, especially twins which share a placenta for their nutrition and growth. So, the recommendations do differ from a singleton pregnancy, where expectant mothers are advised to minimise their weight gain during their first trimester when their energy (or calorie) demands are in fact the same as they were during pre-pregnancy.
In the case of multiples, weight gain may need to begin earlier in the pregnancy to ensure your babies’ weight status is optimised in order to reduce the risk of complications should pre-term birth occur.
This does not translate to a huge difference in the amount of weight gain for a twin pregnancy compared to a singleton pregnancy. For a woman with a healthy pre-pregnancy weight, a singleton pregnancy would require 11.5-16 kg total weight gain for the entire pregnancy. On the other hand, a woman with a healthy pre-pregnancy weight who becomes pregnant with twins should aim to gain around 16.8-24.5 kg. As you can see, the total weight gain required during a pregnancy is not exactly double for a twin pregnancy compared to a singleton pregnancy!
There are currently no agreed energy targets for twin and multiple pregnancies. However, some researchers suggest aiming for between 12,550-14,660 kilojoules (or 3,000-3,500 calories) per day for women entering pregnancy who are in the healthy weight range. There are different targets for women entering pregnancy who are in the overweight or obese weight ranges.
Unfortunately, there is not enough data yet to give specific weight gain guidelines for triplet, quadruplet, or higher order pregnancies at this time. Working with your healthcare professional and following their advice based on your own unique needs is key.
Beyond gaining enough weight and getting enough energy or calories into your day to support yourself and your growing babies, you may also need to consider your increased requirements for other nutrients.
Multiple pregnancy nutritional requirements
Protein is important for ensuring the normal growth of your babies in the case of multiple pregnancies. Foods rich in protein include meat, chicken or turkey, fish and seafood, eggs, dairy foods such as milk, legumes and beans, tofu as well as nuts and seeds.
This is because high protein foods tend to be rich in key minerals such as iron and zinc (more on this later in this article).
However, you should avoid organ meats such as liver and patè during pregnancy as they are often very high in vitamin A, which can be toxic to your babies.
Folic acid and its naturally occurring form in food, folate, are important in the creation of your baby's genes and rapidly growing cells. Women who are pregnant with twins require higher amounts of folic acid to help avoid folate deficiency anaemia, which can lead to neural tube defects in your babies.
Research suggests that women who are pregnant with twins are eight times more likely to become anaemic due to folate deficiency than women with singleton pregnancies! This can leave you feeling fatigued and could potentially affect your babies’ development.
There is currently no agreed target for folic acid for women with twin and multiple pregnancies. However, some researchers suggest that aiming for 1000 micrograms (mcg) of folic acid each day is reasonable for twin pregnancies.
Taking a pre-pregnancy and pregnancy nutritional supplement that contains folic acid is important for all pregnancies. Speak with your healthcare professional to discuss what might suit your needs.
Calcium is a commonly overlooked nutrient by many women, with over 70% of Australian women aged 19-30 years not getting enough calcium each day!
Your growing babies will demand additional calcium, especially in the third trimester to help build their bones. This means that if you do not increase your calcium intake during pregnancy to factor in this additional demand on top of your own daily needs, your bones may end up being compromised to build your babies’ bones!
International and Australian recommendations suggest aiming for 1000 milligrams (mg) of calcium daily. The best sources of calcium are dairy foods such as milk, yoghurt and cheese.
There is yet to be an agreed calcium target for twin pregnancies. However, it is best to ensure your diet contains 3 and ½ serves of dairy each day (find out what a serve looks like here, and to discuss calcium supplementation with your healthcare professional, as some medical factors may mean you need more or less calcium.
One serve of a2 Nutrition for Mothers™ made with 200 mL of a2 Milk™ Light provides you with 769 milligrams (mg) of calcium as well as 15.9 grams of protein providing a great contribution to those daily targets for your multiple pregnancy. Two servings per day are recommended .
Iron is a critical nutrient in any pregnancy, especially in the second and third trimesters when blood volume increases to support your growing babies. This is only magnified in a multiple pregnancy, with research showing up to 4 times higher rates of iron deficiency anaemia amongst women who are pregnant with multiples compared to women with singleton pregnancies. Anaemia can leave you feeling fatigued, dizzy, and having trouble concentrating.
Monitoring your iron levels closely with your health care professional is crucial during your multiple pregnancy. Ensure that you are eating iron-rich foods such as red meat, fish, poultry and eggs, iron-fortified breads and breakfast cereals, beans and pulses, dried apricots and leafy green vegetables. For most women, a specially formulated pregnancy nutrition supplement is a vital component of their twin pregnancy diet.
Zinc is another important mineral for multiple pregnancies which can be found in protein-rich foods such as meat, seafood and fish, eggs, beans and pulses, nuts and seeds.
About 1 in 10 Australian non-pregnant women do not meet their daily zinc targets. Researchers recommend increasing your daily zinc intake if you are pregnant with twins. This can be met by ensuring you incorporate high protein foods in your daily diet, as well as taking a pregnancy nutritional supplement that contains zinc. a2 Nutrition for Mothers™ contains 3.6 mg of zinc per serve to help you meet your needs - two servings per day are recommended.
Currently there is not enough data to provide a specific target for higher order multiple pregnancies such as triplets and beyond.
Being pregnant with multiples does mean you have additional nutrient needs. Paying careful attention to your diet and your pregnancy supplements is essential to help support the healthy growth and development of your babies. Consider working with a dietitian for individually tailored advice for your pregnancy needs.
For more information on nutrition in pregnancy, click here
Article written by fertility & prenatal dietitian & nutritionist Stefanie Valakas, The Dietologist.