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Dietary recommendations for multiples pregnancies are set out to optimize fetal growth and development, reduce pregnancy complications such as preeclampsia, gestational diabetes and preterm delivery, increase gestational age at delivery, and avoid excess maternal weight gain that could lead to weight retention after the babies are born.

Calorie needs increase to about 600 more per day than your normal pre-pregnancy diet for twins, and up to 900 calories more for triplets. These calories can be spread throughout the day into mini-meals and snacks once eating larger meals become uncomfortable for most women later in pregnancy.

When it comes to increased nutrients, you’ll need more folic acid, protein, zinc, magnesium, iron, vitamin D and calcium. Read about specific food sources and other tips for upping your intake in the WHAT TO DO section.

And don’t forget about drinking water. With more than one amniotic sac, you’ll need to increase your fluid intake throughout the day, especially as there seems to be a link between dehydration and preterm labor.

Gaining the right amount of weight helps support your babies’ health and development, which is particularly important for pregnancies with twins or multiples because of the increased risk of preterm labor and low birth weight.

Weight gain recommendations vary from woman to woman based on a number of factors such as body size and pre-pregnancy weight, but in general for a twin pregnancy, the recommendation is 35-45 pounds and for a pregnancy with triplets it’s 50-60 pounds. Women carrying twins typically gain about 4-6 pounds during the first trimester and 1-2 pounds per week during the second and third trimesters. Women carrying triplets can expect to gain between 1-2 pounds per week for the entire pregnancy.

It may feel like you need a complete diet overhaul to keep up with the demands of growing more than one baby, but if you’re already consuming a generally healthy and balanced diet, continue eating this way.

What to Do

Talk to your healthcare provider to determine your weight gain goals

Meet those weight gain goals by increasing your daily calories with nutrient and fiber rich foods. Add healthy snacks and mini meals to comfortably increase your calorie intake.

Track your fluid intake throughout the day to ensure you’re getting enough

If you’re bored with plain old water, try enhancing your water with lemon, cucumber, or orange slices, or flavor it with fresh herbs such as mint or basil.

In addition to taking your prenatal vitamin, increase food sources of crucial nutrients

These crucial nutrients include:

• Folic acid from broccoli, spinach, chickpeas, beans and lentils
• Protein from fish, poultry, dairy, eggs, beans and nuts. Protein needs significantly increase when carrying multiples as it helps build both your tissues and your babies’ bodies. Make sure all of your meals and snacks contain a healthy source of protein to meet your needs and keep you satisfied throughout the day. Aim for 100g of protein or more per day when carrying twins. Some sources recommend an additional 25g a day for each baby.
• Zinc from poultry, beans and nuts
• Magnesium from beans, nuts and whole grains such as brown rice and whole wheat bread
• Iron from beans, meat, nuts and dark leafy green vegetables. Women carrying more than one baby are at higher risk for iron-deficiency anemia, so consume iron rich foods alongside vitamin C rich foods to help with absorption. Speak to your healthcare provider about taking an iron supplement if necessary.
• Calcium from dairy, tofu, dark leafy green vegetables, almonds and canned fish with bones
• Vitamin D from fortified dairy products and fatty fish (and see What’s the deal with seafood? for more specifics on recommended types of fish). Note that it can it can be difficult to reach the recommended amount of vitamin D from diet alone. Most of our vitamin D comes from a hormone our bodies make from exposure to sunlight. In addition to needing at least 15 minutes of sun exposure a day (on skin not protected by sunscreen), the Institute of Medicine suggests we might all benefit from vitamin D supplementation.

Keep a food log to make sure you’re getting enough calories and protein throughout the day