Multiple gestation pregnancies are increasing dramatically in the United States. This often leads to increasing frequency of low birth weight infants, preterm labor and other conditions associated with high risk pregnancies. Nutrition is a key element to reducing the risk of birth defects, suboptimal fetal growth and development and chronic health problems for both mother and child. Nutritional intervention has been proven consistently to improve outcomes in multiples.
Weight gain recommendations are based on pre -pregnancy Body Mass Index ( BMI ) whether for singleton pregnancies or multiple gestations. Twins and higher multiples do require both more calories and increased weight gain (over a singleton pregnancy). The following are guidelines that I have gathered from the literature:
Singleton: Twins: Triplets: Quadruplets:
Underweight (< 18.5 BMI) 28-40 lbs. No guidelines established
Normal weight (18.5-24.9 BMI) 25-35 lbs. 37-54 lbs. 50-60 lbs. 65-80 lbs.
Overweight (25-29.9 BMI) 15-25 lbs. 31-50 lbs.
Obese (> 30 BMI ) 11-20 lbs. 25-42 lbs.
Some additional things to consider:
Multiple gestation in a woman's first pregnancy: Gain an additional 5-7 lbs as quickly as possible
Multiples as a result of infertility treatments: Gain an additional 4-6 lbs. during the first half of the pregnancy
(This has been shown to decrease the liklihood of miscarriage-reason unknown)
Smokers or those who have recently quit smoking should gain an additional 5-7 lbs. to help replace nutrients lost through smoking and to replenish lost nutrients.
The pattern of weight gain is also important when having multiples. This is because often multiples do not go to term, so early weight gain is important. Weight gain in the first 24 weeks has the most influence on
weight gain after 24 weeks.
The recommendation is as follows: Before 24 weeks After 24 weeks
Goal weight gain/week Goal weight gain/week
Singleton 1/2 lb. 1 lb.
Twins 1 lb. 2 lbs.
Triplets 1 1/2 lbs. 2 1/2 lbs.
Quadruplets 2 lbs. 3 lbs.
How many calories are needed for appropriate weight gain?
The following guidelines (based on pre -pregnancy weight) can be used to estimate individual needs:
Singleton:
Normal pre -pregnancy weight: 30 calories/kilogram(kg.) (1 kg = 2.2 lbs.) Your weight/2.2=weight in kg.
Overweight: 24 calories/kg.
Underweight: 36-40 calories/kg.
Twins: Add 500 calories per day to the above recommendations as soon as the multiple pregnancy
is diagnosed.
If you need assistance with determining or reaching goals, seek out a nutrition professional/Registered Dietitian who works with high risk pregnancies.