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Eating for Three (or More)

The Special Nutritional Needs of
Moms Carrying Multiples
By Lisamarie Sanders

When I was pregnant, I often used the justification that I was "eating for two" after taking a second serving of mashed potatoes. The same excuse was used for the extra large piece of pie and my late-night forages in the freezer.

Christi Gillentine, a mother of twins from Tulsa, Okla., had an even better excuse. She was eating for three.

"There's a bigger nutritional drain on a mother when she's carrying more than one baby," says Barbara Luke, a professor of obstetrics and gynecology at the University of Miami.

Most women pregnant with one child need 300 more calories each day; women pregnant with twins or other higher order multiples require significantly more calories to give their babies the nutrients they need.

"A typical diet prescription may be 3,500 calories per day for twins and 4,500 per day for triplets," says Doreen Chin Pratt, director of nutrition services at Women and Infants' Hospital of Rhode Island. Remember, however, that the majority of these calories should come from nutrient-rich foods, not French fries and candy bars.

Putting on the Pounds
Of course, eating more means gaining more weight. "I gained about 80 pounds when I was pregnant with my twins," says Gillentine, noting that this was twice as much as she had gained with her firstborn. "Many women are freaked out when they're told to gain 40 to 50 pounds or more. I thought it was more important that I didn't worry about my weight or size – I just wanted healthy babies."

Luke, the co-author of When You're Expecting Twins, Triplets, or Quads: A Complete Resource (Harper Collins, 1999) and Program Your Baby's Health: The Pregnancy Diet for Your Child's Lifelong Well-Being (Ballantine Books, 2001) says that many of her larger patients are concerned about gaining weight.

"They'll ask, 'Can't the baby just live off my fat stores?'" she says.

Unfortunately, she explains, it doesn't work that way. The developing fetuses get nutrients directly from the mother's blood supply. If Mom doesn't eat properly, she and the babies will become malnourished.

It's not only what you gain, but also when you gain it that makes a difference in a multiple pregnancy. "We like to see targets of 24 pounds by 24 weeks in twins, 34 pounds by the same time with triplets," Pratt says.

Luke explains that the weight women gain in the first half of pregnancy benefits multiple babies throughout pregnancy. "It's like putting money in the bank where it gains interest," she says. And, like a savings account, the money will be available when it needs to be drawn upon.

Supplemental Information
Although eating more will give multiple babies many of the nutrients they need, dietary supplements also play a useful role in growing healthy babies.

"Most women are not in the best nutritional shape when they get pregnant," says Luke. They may have low iron stores, poor protein consumption and many have been dieting. More than half of the pregnancies in this country are unplanned, so women – especially those pregnant with multiples – have to pump up their nutrition quickly. Vitamin supplements can help.

In addition to vitamins, Luke advises her patients to take extra magnesium and zinc. "Magnesium works to quiet muscles, and that's all the uterus is," she says. Taking a magnesium supplement throughout pregnancy reduces the risk of pre-term labor.

Zinc is useful for fighting infection, making pregnant women less likely to get sick. As an added benefit, it also reduces the likelihood of stretch marks.

Before taking any supplements, be sure to discuss the benefits and risks with your doctor.

Pumping Iron
Iron is critical for a healthy pregnancy, and this is especially true for moms carrying multiple fetuses. To help them get the amounts they need, many doctors prescribe iron supplements for their patients.

Although she agrees that pregnant women need more iron, Luke suggests making dietary changes instead of taking supplements. "Supplemental iron is non-heme iron," she explains, which means it does not come from blood products. This type of iron has only about a 10 percent absorption rate and is affected by everything a pregnant woman eats. "Cereals are a good example of this. Some claim to have 100 percent of the Recommended Daily Allowance (RDA) for iron, but once you add milk, the calcium binds the iron, and it goes through your system undigested."

To ingest the correct amounts of iron, Luke recommends eating more foods that contain heme iron, or blood iron, which the body is better able to absorb. Foods like fish, eggs, poultry and especially red meat are excellent sources of heme iron. "You need the B vitamins, proteins and everything else from the hem-iron-rich foods, too," she adds.

Got Milk?
In addition to extra iron, women carrying multiples require extra calcium. "When I was pregnant with my twins, I ate as much calcium as I could – for them and for myself," Gillentine says. She knew that if the babies didn't get enough calcium from her diet, they would take it from her bones.

If you are not a big milk drinker, consider other sources for calcium. Cheese, yogurt and calcium-fortified orange juice are alternate ways to get this important nutrient. However, if you find that you can't get the full amount of required calcium in your diet, talk with your doctor about adding a supplement. Luke recommends 3 grams of calcium per day, because in addition to creating strong bones and teeth in both Mom and the babies, "calcium is the only nutrient shown to reduce the risk of pre-eclampsia."

The Rules for Eating for Three (or More)
In addition to eating healthfully, eating more and taking necessary supplements, there are some other eating "rules" for women pregnant with multiples:

  • Eat at least six small meals and snacks a day. Eating every three to four hours will keep your blood sugar from dropping. Low blood sugar can be damaging to your nervous system and can cause pre-term labor.
  • Eat proteins and carbohydrates together. If you eat just carbohydrates, like plain fruit or crackers, your blood sugar could have too much fluctuation. Put some peanut butter on the fruit or cheese on the cracker.
  • Have dairy before bed. Sending your husband out for ice cream at midnight is actually good for you! Dairy is broken down slowly, so it will keep your blood sugar steady through the night. Milkshakes, cereal with milk or grilled cheese sandwiches are all excellent choices before turning in.
  • Drink water. Water has numerous benefits: It helps you focus, prevents constipation and decreases the risk for urinary tract infections. It reduces dry skin and increases energy. Keep a bottle of water by your side at all times, and drink no less than 2 quarts a day.

But birth weight is not the only reason for getting adequate nutrition during pregnancy. Luke reminds mothers, "How the babies grow before birth will affect their life after birth."

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About the Author: Lisamarie Sanders is a mother and frequent contributor to iParenting.com.

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