Nicole Moroney is a Nutrition Plus dietitian who has been working in private practice in the South-Eastern suburbs of Melbourne for the past 10 years. She is passionate about women’s health, in particular working with couples who are trying to conceive and pregnant women. She speaks with Melanie McGrice on the best pregnancy nutrition for twins.

Q. What nutrients are particularly important to consume during pregnancy?

Women have increased nutritional needs during pregnancy. We want to ensure women get enough energy (measured by kilojoules (kj) or calories (cal)) to ensure a healthy weight gain to meet the needs of the growing baby. Protein is important to help build the baby’s muscles and organs. Key vitamins and minerals also include:

• Folate
• Iodine
• Iron
• Calcium
• Vitamin D
• B12
• Omega 3 fatty acids

The best way to get these nutrients is to eat a healthy balanced diet – but pregnancy vitamin supplements are also helpful.

Q. Are the requirements for these nutrients higher for twin pregnancies?

Unfortunately, there isn’t much research out there specifically for women expecting twins. When you’re pregnant with twins, more nutrients are required to meet the needs of your developing babies and for your own well-being but there hasn’t been enough studies yet to determine how much of the specific nutrients are required for pregnancy with twins.

The focus is on trying to have a good quality pregnancy diet and eating regular meals with lots of variety.

Q. Do mothers of twins need increased nutritional supplements during pregnancy?

Some people think that being pregnant with twins means you need to take an extra pregnancy vitamin.  This isn’t the case – in fact, having too many vitamins and minerals can be harmful. 

There are studies suggesting women pregnant with twins have 2-4 times higher rates of iron-deficiency anaemia than women carrying only one baby and iron deficiency is linked with pre-term birth. There’s also evidence indicating a higher risk of folate deficiency. As it can be difficult to get enough iron and folate from food alone, some women pregnant with twins may benefit from additional iron and folate supplements. Extra supplementation of calcium, vitamin D and omega-3 fatty acids could also be considered but the precise micronutrient requirements in women pregnant with twins is unclear.

It’s recommended women take a good pregnancy multivitamin, then use blood tests and dietary assessment to see if any extra supplements are needed. It’s important to tailor this to the individual.

Q. Do women pregnant with twins need to eat twice as much?

I love that people say if you’re pregnant with one then you’re eating for two, so if you’re pregnant with twins you must be eating for 3! Unfortunately this isn’t the case. Energy requirements or how many extra kilojoules or calories you need to eat during pregnancy is quite individual. It varies depending on the women’s pre-pregnancy weight and activity level and it changes over the course on the pregnancy.

Extra energy is needed to help you gain enough weight to meet the needs of your growing baby but not too much. Getting the balance right affects your health, your babies’ health and also the health of your babies later in life.

A women carrying twins is likely to put on more weight than a woman expecting one baby. But before you get too excited, most women don’t need to eat a lot more when they’re pregnant and if you’re pregnant with twins there’s certainly no need to eat for three.  I think it’s a good time to try to eat twice as healthy, not twice as much.

Q. What if they are struggling with morning sickness and may not be able to eat enough?

Every pregnancy is different but women pregnant with twins have more pregnancy hormones and therefore they’re more likely to experience nausea and vomiting during pregnancy.

To help manage nausea there’s lots of tips that could help. I recommend:

• small frequent meals
• sipping on drinks throughout the day
• a small carbohydrate snack, like a couple of crackers, first thing in the morning
• avoiding high fat foods
• avoiding cooking smells can help so having more cold foods or getting someone else to cook for you if possible
• ginger may help
• reducing your iron supplement might also be considered if appropriate and in conjunction with a health professional.

I suggest to my clients to eat whatever pregnancy safe foods appeal to them and to eat as well as they can when they’re feeling their best. That said, if you find you’re struggling to eat or keep anything down you need to talk to your obstetrician or doctor.

Q. What about weight gain in pregnancy for women pregnant with twins?

The Institute of Medicine has released guidelines on weight gain during pregnancy based on pre-pregnancy BMI. For a woman in the healthy weight range before she gets pregnant, the recommendation is to gain 11.5-16kg throughout her entire pregnancy. However, for women pregnant with twins, that recommended weight gain recommendations increase to 17-25kg.

Q. And what about the rate of that weight gain?

The rate of weight gain in pregnancy with twins has also been shown to be important. For women expecting twins, they’re 60% more likely to give birth before 37 weeks compared to singleton pregnancies and the babies are more likely to have a low birth weight. So, we really want to make sure those babies gain weight in the earlier stages of pregnancy, particularly the first two trimesters.

There was a study of around 650 twin babies born looking at how much weight the woman had gained throughout her pregnancy and found the optimum weight gain for twin outcomes (measured in this case as birth weight of over 2.5kg), and it found that the best outcomes were linked to 11kg of weight gain by 24 weeks. For women pregnant with twins, the emphasis is on gaining weight in the first trimester.

Do you have any other tips or suggestions for those who are pregnant with twins?

Not all pregnancies are the same, but we know that women carrying twins have higher levels of pregnancy hormones. They are more likely to have nausea and vomiting, be more tired and will probably get bigger than women with a single pregnancy.

When a couple find out they are having twins it’s sometimes an exciting time but it can also be quite a stressful time. Women pregnant with twins are usually busier with more appointments and monitoring more likely to feel overwhelmed. If you feel like you need support with your diet, reach out to a pregnancy dietitian. They can walk you through how much weight you should gain, what you should be eating or which supplements to take. We’re there to give you the information you need, support you through your pregnancy and give you the confidence to know you’re doing the best you can for your health and that of your unborn babies.