Sure, you’re more tired, more nauseated and just about more everything since you’re carrying multiples. But there’s at least one upside: You've got a license to eat! Moms of twins get to indulge in an extra 600 calories a day — doctor’s orders. (And if you’re carrying more than two babies, your calorie needs are even higher.)
But before you take that as a free pass to Burritoville (extra guacamole for Baby A; refried beans for Baby B), think again. The quality of what you eat will be just as important as the quantity. In fact, good nutrition during a multiple pregnancy has an even greater impact on baby birth weight than it does during a singleton pregnancy.
Even with the best intentions, however, there will definitely be challenges when it comes to eating right. As your pregnancy progresses, there will be less and less room in your belly for food. And that’s not metaphorically speaking: Your babies will literally take up space usually inhabited by your stomach and esophagus (hence the heartburn many moms of multiples experience).
Since you’ll still have to do your best to eat the foods you and your babies need most, you’ll require a good strategy: Eat several smaller meals a day (petite platefuls take up less room going down but deliver the same nutritional punch at the end of the day). And common sense requires that you choose foods that pack plenty of nutrients into small servings.
So how do you get the biggest nutritional charge for the calories you consume? Here’s everything you need to know about maintaining a healthy diet for a twin and multiple pregnancy.
How much should I eat when I’m pregnant with twins and multiples?
Women carrying multiples should consume an extra 300 calories for each additional baby, according to the American College of Obstetricians and Gynecologists (ACOG). That means you’ll need to eat 600 extra calories per day on top of what you were having pre-pregnancy if you’re pregnant with twins (or 900 extra calories per day if you’re expecting triplets!).
More About Twins
Just like moms-to-be of singletons, moms-to-be of multiples should take a daily prenatal vitamin to support their babies’ growth and development. That said, since your needs for certain nutrients — especially iron, folate, calcium, magnesium and zinc — are even higher when you’re carrying two or more, your practitioner may recommend taking additional supplements to fill in the gaps.
What foods should I eat while pregnant with twins and multiples?
Wholesome, nutrient-dense food is the name of the game. While it’s perfectly fine to enjoy the occasional treat or splurge, make sure the majority of those extra calories come from nutritious foods that best nourish your babies and your pregnancy.
In general, moms of multiples should fill up on the same types of foods that support a healthy singleton pregnancy. (No matter how many babies you have growing, they all need the same nutrients!) But since twin pregnancies come with greater nutritional needs overall, it’s even more important to choose menu items that deliver the biggest vitamin and mineral bang for your buck. These pregnancy super foods fit the bill.
Lean proteins
Protein is a mom-to-be’s best friend, especially for those carrying multiples. Eating ample amounts may help prevent preeclampsia, gestational diabetes and preterm labor (all more common in multiple pregnancies). Protein is also essential for building uterine muscle fiber and for fueling the increased blood volume required to nourish two or more babies.
Women carrying twins should aim to get around 100 grams of protein per day. If that seems like a lot, think of yourself as a body-builder bulking up for a big competition. (After all, what are you doing if not building new little bodies?) Some of the best choices include:
Lean meats, including beef, pork, turkey and chicken, which will earn you the most bang for your protein buck (7 grams of protein per ounce!). They’re also one of the best sources of iron, another key nutrient for moms of twins.
Low-fat yogurt (especially Greek yogurt, which is higher in protein), milk, cheese and cottage cheese, which also deliver calcium. You can rev up the protein content of your milk, oatmeal or smoothies by adding a spoonful or two of powdered milk.
Seafood, especially omega-3-rich fatty fish like salmon, anchovies or canned light tuna. Other low-mercury options like shrimp, tilapia and cod are also good choices. Aim for two to three servings of low-mercury fish a week.
Eggs, which serve up 6 to 8 grams of protein each along with vitamin D and choline.
Beans, including chickpeas, lentils, black beans, kidney beans and white beans. Each ½-cup serving delivers 7 grams of protein, which is the same as an ounce of meat.
Tofu, which gives you around 10 grams of protein per ½-cup serving and brain-boosting nutrients like choline.
Iron-rich foods
Iron helps your body manufacture red blood cells (you’ll need lots of those for the increased blood you’ll be pumping) and prevents maternal anemia, a common problem in multiple pregnancies. Anemia (which occurs when the number of red blood cells falls below normal) can cause your appetite to decrease and your fatigue to increase (yes, it’s possible for you to be even more tired) as well as reduce the amount of oxygen that reaches your organs and your developing babies.
Your goal: Get 30 milligrams of iron daily during your first trimester and 60 grams daily during your second and third trimesters. Your prenatal vitamin will likely get you part of the way there, but iron-rich foods are also a must. Some of your best choices include:
Lean, red meat and dark meat poultry
Fish
Beans and legumes, like lentils, chickpeas and black beans
Iron-fortified cereals
Prunes or prune juice
Iron is most easily absorbed when eaten with foods containing vitamin C (like orange juice, broccoli or strawberries). Coffee, tea and soda drinkers should know that consuming caffeinated beverages with high-iron foods will reduce the amount of iron that your body absorbs (one more reason to kick or limit the caffeine habit, at least for a while).
Even with a daily prenatal and an iron-rich diet, your practitioner may still recommend an additional iron supplement. These can cause constipation and nausea, so try to take them with meals. If the supplements give you tummy trouble, try taking several small doses a day, instead of one large one, or look for a slow-release supplement. This may not only help relieve your digestive problems but also help your body absorb and utilize the iron most effectively.
Fruits and vegetables
Here’s another food group that deserves some precious abdominal real estate. Your developing babies need their micronutrients (folate, vitamin C and vitamin A, to name a few) and you need the fiber. Hormonal changes during pregnancy slow down your gastrointestinal goings-on, but you can minimize or avoid constipation (and that delightful side effect, hemorrhoids), if you save room every day for fresh fruits and vegetables.
The challenge, of course, is that fruits and veggies are bulky — and you’ve got plenty of bulk in your belly already (thank you very much). What to do? Instead of indulging in huge salads (like you used to when it was just you), stock your fridge and purse with small, easy-to-eat goodies like berries, grapes, baby carrots and grape tomatoes and graze all day. Dried fruit like prunes, figs, apricots or dates is another good option because it retains all the nutrients and fiber in a smaller package. But don’t go overboard: dried fruits can cause gas.
Folate-rich foods
Folic acid (or folate in food form) plays a critical role in reducing your babies’ risk for birth defects of the brain or spinal cord, including spina bifida. And if you’re carrying twins or multiples, you’ll need more than the standard 400 to 600 daily milligrams that’s recommended for moms of singletons.
How much more? Some practitioners say that moms of multiples should aim to get 1,000 daily milligrams of folic acid, and your doctor may recommend making up the difference with an extra supplement on top of your regular prenatal vitamin. But you should also fill up on food sources of folate. Some of the best include:
Green vegetables, including leafy greens, broccoli, brussels sprouts and asparagus
Fortified cereals
Fortified grains, like pasta, rice or bread
Avocado
Kidney beans
Nuts and seeds
They might be small, but their nutritional profile is mighty. Nuts and seeds are rich in magnesium, which helps manufacture and repair your body tissue, regulate insulin and blood sugar levels, and build your babies’ strong bones and teeth.
They also deliver zinc, potassium, vitamin E, protein, fiber and healthy fats — all in a tiny package that won’t take up too much room in your stomach.
Stock up on a variety of your favorites and rotate your snack selection regularly. Walnuts, almonds, peanuts, pumpkin seeds and sunflower seeds are particularly wholesome choices. Flaxseed is good too — it's got omega-3s — so try stirring it into oatmeal or adding it to smoothies.
Fatty fish
Fatty fish like salmon, canned light tuna and anchovies aren’t just top sources of protein. They’re also rich in omega-3 fatty acids, which support your babies’ eye and brain development, along with vitamin D to aid in the growth of healthy bones and teeth. Aim to get at least two 8-ounce servings a week, experts recommend.
Low-fat dairy
You know it’s a must for building those tiny bones and teeth. But getting enough calcium is crucial for you too, since your body will take from your own supply if your babies aren’t getting what they need. Yogurt (especially Greek yogurt), milk, cheese and cottage cheese are all good choices.
Moms carrying twins and multiples have even higher calcium needs — around 1,200 milligrams during your first and second trimesters and 1,600 milligrams during your third. If you’re struggling to get your fill from food, talk with your practitioner about adding a supplement.
Water
Drink water throughout the day, not just when you’re thirsty. Dehydration can lead to preterm labor, and that’s something moms-to-be of multiples are already at risk of.
Down eight to 12 glasses of water a day, and don’t wait for mealtime. Drinking between meals rather than with them will keep fluids from competing with solids for precious space in your ever-more crowded belly. One sign that you’re well-hydrated is constant trips to the bathroom (take a peek in the potty — urine should be pale in color when your fluid intake is sufficient).
What foods should I avoid while pregnant with twins and multiples?
No matter how many babies you’re carrying, the list of pregnancy foods to avoid is the same. Certain items pose a higher risk for harboring bacteria or chemicals that could make you or your babies sick. You should steer clear of:
High-mercury seafood
That includes swordfish, king mackerel, orange roughy, bigeye tuna and tilefish from the Gulf of Mexico. Stick with low-mercury options instead — think wild salmon, shrimp, catfish, tilapia, canned light tuna, lobster or crab.
Raw or undercooked meat, eggs or seafood
That includes rare burgers or steaks, runny eggs, sushi and uncooked smoked seafood like nova or lox. (Smoked seafood is fine if it’s part of a cooked dish, like a casserole.) Raw or undercooked proteins can harbor bacteria that can lead to serious illness. Use a meat thermometer to check the temperature of meats or seafood, and cook eggs until the yolks and whites are firm.
Hot dogs or deli meats
Both can be sources of listeria, a bacteria that can cause a serious infection. The one caveat: It’s okay to have hot dogs or deli meat if they’ve been cooked until they’re steaming hot.
Unpasteurized foods
That includes raw milk, unpasteurized juices and cheeses made from raw milk. (Soft cheeses like brie, feta or blue cheese are the biggest offenders, so steer clear or check the label to confirm the cheese is made with pasteurized milk.)
Unwashed fruits and vegetables and raw sprouts
Unwashed fruits and vegetables are more likely to harbor illness-causing bacteria than their washed counterparts. The Centers for Disease Control and Prevention (CDC) advises that you wash or scrub fruits and vegetables under running water even if you're not going to eat the peel, since germs on the outer skin can get into the fruit or vegetable when you cut it. Raw sprouts are risky even after they’ve been washed, so you should avoid them completely.
Alcohol
Drinking alcohol while you're pregnant increases the risk of miscarriage and stillbirth as well as certain birth defects. Since no amount of alcohol is known to be safe during pregnancy, the best thing to do is to avoid it completely.
Excess caffeine
Up to 200 milligrams of caffeine daily — roughly the amount in one 12-ounce cup of coffee — is safe for most moms-to-be. But consuming more than that may slightly increase the risk of miscarriage. Pay attention to how much you’re getting from your daily java as well as other sources like tea, energy drinks, chocolate or soda.
Meeting your nutritional needs during a twin or multiple pregnancy is important. But don’t let it become overwhelming. By taking your prenatal vitamins plus any supplements recommended by your provider, aiming to eat a wide variety of healthy foods, and keeping empty-calorie snacks (like chips and cookies) in check, you’ll get all the good stuff your babies need to grow and thrive. And you’ll feel your best too!
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