Being a mom of twins is a source of joy! But getting from mom-to-be to mom might seem overwhelming, especially when it comes to eating! You already know being pregnant with twins (or more) is different than what moms just pregnant with one baby go through. Some facts to consider about twin pregnancies are:
- When compared to singleton pregnancies, women pregnant with multiples have increased risks for things like hypertension, anemia, gestational diabetes, and cesarean delivery. They are also at greater risk of preterm births and delivering low birth weight babies.
- The good news is that your diet can make a difference to those high-risk outcomes and can also make a difference to your kids’ long-term health. Research indicates that adequate nutrition during pregnancy is an important modifiable factor that impacts maternal and child outcomes.
- A balanced diet is necessary for the health of the mother and the baby. A diet with enough carbohydrates, protein, folic acid, vitamin D, calcium, iron, and adequate hydration is essential. Below we’ll discuss how to get enough of all those nutrients.
Pregnant women need carbohydrates because they are the main fuel source for the entire body and the brain. Carbohydrate needs for moms-to-be pregnant with twins are higher. You need to eat at least 208 grams of carbohydrates each day to help with your weight gain and the babies’ development. Complex carbohydrates are the best for growing babies in the womb and provide vitamins, minerals, and fiber. Complex carbohydrates include starchy vegetables, green vegetables, beans, and whole grains- and because of their fiber content, they help balance blood sugar. They can help you feel full longer because it takes more time for your body to break down complex carbohydrates.
Protein is required to help with the babies’ growth and development in the womb, and help fuel your increased blood volume. Women pregnant with twins need to consume an additional 50 grams of protein per day above their recommended non-pregnant daily protein needs. Animal-based protein sources such as dairy, red meat, poultry, and fish are good. It is preferred and safe to consume fish with lower amounts of mercury and in smaller portions (12 ounces or less), such as trout, salmon, or cod, 2 or 3 times per week. (Click here to learn about seafood sources of DHA for pregnancy)
Eggs are another excellent protein source, providing vitamin D and choline. Choline is the nutrient that helps to regulate muscle control, memory, and mood! If you don’t consume animal-based protein sources, you need to try plant-based sources in your diet, including legumes, beans, tofu, nuts, and seeds. You can even add nuts and seeds straight into your smoothie!
Folic acid (vitamin B9) helps decrease your babies’ risk for brain, spine, or spinal cord birth defects. To prevent these birth defects, moms-to-be of multiples need 1 mg (1000 mcg) of folic acid daily. Most prenatal supplements contain 0.4 to 0.8 mg of folic acid, so additional supplements may be necessary. Though you can get folate, another form of folic acid, from food, it’s recommended that all of the folic acid come from a supplement or fortified food.
Folic acid is referred to as folate when naturally found in food. Foods high in folate include kidney beans, avocado, and leafy green vegetables. Leafy green vegetables include broccoli, kale, brussels sprout, asparagus, romaine lettuce, and spinach. One cup of spinach (raw) has about 15% of the Daily Value for folate. Folic acid is not naturally present in foods, and it’s instead added to them. Fortified foods with the best sources of folic acid include grains such as bread, pasta or rice, and some cereals.
Vitamin D helps your body to absorb and use calcium. It is common for pregnant women to be vitamin D deficient. If you are pregnant with twins, your vitamin D requirements are greater, you need 600- 1200 IU daily. These recommendations vary by country. Some of the best natural food sources of vitamin D include fatty fish such as tuna, salmon, and trout. Fortified foods with vitamin D include milk and some brands of orange juice. Since you cannot get vitamin D from only food sources, it is recommended to get some sun outside so that your body can make its own vitamin D.
It is crucial that you get enough calcium for your bone health and teeth. Milk, Greek yogurt, low-fat mozzarella, and swiss cheese are rich sources of calcium. Carrying two or more babies means higher calcium needs of up to 2000-2500 mg/day. (The advice also varies between countries.) If your babies are not getting needed amounts of calcium, your body will take calcium from your own supply. Therefore, getting enough calcium is essential!
Iron helps your body produce red blood cells and prevents the development of iron deficiency anemia during pregnancy. If you have anemia, you may feel tired, dizzy, or short of breath. In addition to your diet, you may need to take additional supplements to get enough iron. Speak to your health care provider about how much you need.
Two types of iron come from food sources, heme iron and non-heme iron. You can obtain heme iron from animal-based sources such as eggs, red meat, poultry, pork, salmon, tilapia, and light tuna. You can get non-heme iron from plant-based sources such as dark green leafy vegetables, iron-fortified cereals, beans, and legumes. Kidney beans, black beans, chickpeas, and lentils are good sources of iron. Non-heme iron is not absorbed well enough as heme iron. To better absorb non-heme iron from plant-based foods, add vitamin C, such as broccoli, oranges, and strawberries. To obtain more iron in your breakfast oatmeal, add fruits such as blueberries!
How to Eat All That Food!
|Food Group||Servings I Should Eat Each Day||Examples of One Serving|
|Bread (preferably multigrain), high fiber cereals, rice, pasta, noodles||10|
1 slice of bread, half a bread roll, 2/3 cup cereal flakes, half a cup of cooked pasta, noodles, rice, 3 crispbreads
|Vegetables and fruit||9|
half a cup vegetables, 1 cup salad, 1 medium fruit e.g., apple or banana, 2 smaller fruit e.g., plums or apricots, 30 g dried fruit
|Milk, yogurt, cheese, soy milk with added calcium||3-4|
1 glass (250 ml) milk, 1 glass (250 ml) soy, rice or oat milk with added calcium, 1 tub (200 ml) yogurt, 1-2 slice (35 g) cheese
|Milk, chicken, fish, tofu, legumes or beans, nuts||4-5|
65 g cooked meat, 80 g cooked chicken or turkey, 100 g cooked fish, 2 eggs, 170 g tofu, 1 cup legumes or lentils, 30 g nuts
|Fluids, preferably water||2 or more above your usual amount|
10 cups (2.5 L) glass water, plain soda/ mineral water, or milk and juice in smaller amounts
|Extra foods e.g., fats & oils, cakes, biscuits, fried foods, potato chips, soft drinks||Have in small amounts or occasionally|
Source: Modified from Healthy Eating When You’re Pregnant with Twins Fact Sheet, The Royal Women’s Hospital.
It’s vital to stay hydrated, especially during the summer months or when it’s especially hot or humid! Dehydration can put you at risk of contractions and preterm labor. Make sure to drink enough water daily, about 10 cups (2.5 L) of fluid per day. I know this may look like a lot of water to drink each day. When you are away from home, a water bottle could be very convenient. I have a 32 oz. water bottle and it has been helpful to keep track of my daily water intake. Some foods high in water content could help you meet your needs, such as fruits, veggies, soup, smoothies, and yogurt. Also, you could try adding fruit, veggies, or herbs to make your water taste more flavorful! You can add citrus fruits, kiwis, strawberries, pineapples, watermelon, cucumbers, or mint to your water.
As you carry your double bundle of joy, you can keep your energy up by eating a balanced diet rich in proteins and carbohydrates that contains enough vitamins and minerals. It’s not always easy to eat all the food you need to do that, so seek help from a registered dietitian nutritionist for specific advice. You can also find more information in other blog posts on this site:
Whitaker, K.M., Baruth, M., Schlaff, R.A. et al. Provider advice on physical activity and nutrition in twin pregnancies: a cross-sectional electronic survey. BMC Pregnancy Childbirth 19, 418 (2019). https://doi.org/10.1186/s12884-019-2574-2
Steinberg, D. (2019). Eating for Three: What to Eat When You’re Pregnant with Twins. Retrieved from https://health.sunnybrook.ca/women/eating-for-three-weight-twins/
Healthy Eating When You’re Pregnant with Twins Fact Sheet. The Royal Women’s Hospital. May 2021.
Alberta Health Services. (2018). Nutrition Guideline Pregnancy: Multiples. Retrieved from https://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-ng-pregnancy-multiples.pdf
Vitamin D: Health Professional Fact Sheet. National Institutes of Health.Updated August 2022.
Alberta Health Services. (2018). Nutrition when Pregnant with Twins, Triplets or More. Retrieved from https://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-nutrition-pregnant-w-twins-triplets-or-more.pdf
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