Nutrition Guide for Multiple Pregnancies — TWINS Magazine
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Nutrition Guide for Multiple Pregnancies

by Marie Christine Umali

A few minutes and five pregnancy kits later, you’ve confirmed that you’re indeed going to be a mom! Now, that’s good news!

Whether it’s your first baby or your 8th, most (if not all) mothers feel the excitement and anticipation building up, as the countdown to THE DAY begins. All the more if you’re carrying not one but two, or even multiple babies inside your small but comfortable oven. Sure, you’ll be more tired, nauseated, cranky, or also gassy at times; however, the joy you feel once you bring beautiful human beings into the world outweighs the tradeoffs. 

But as with anything in life, there is no “one-size-fits-all” approach to dealing with pregnancies. Having the proper knowledge early on allows you to maneuver into the journey seamlessly, ensuring that both you and your babies come out with a glittery, shiny badge that says, “Congratulations! You nailed it!”

Unfortunately, this is where the challenge lies. People typically spend around 17 years of their lives in school, and for medical practitioners, even more. But even then, a lot still don’t know how to optimize their bodies’ potential through the science of nutrition.

According to the Australian College of Midwives, in their published journal on Women and Birththere is indeed a significant knowledge inadequacy when it comes to dietary pregnancy recommendations. Very few women know what to eat and what to avoid during their pregnancy, and midwives are no exemption. In the study, even midwives provided incorrect answers to topics frequently asked by pregnant women about weight gain and nutritional requirements, such as dairy and iodine, to name a few. Such information is vital not only to ensure a healthy pregnancy but also to prevent fetal abnormalities, premature delivery, and pregnancy complications. 

Mothers who are not mindful of the food they eat end up putting themselves and their babies at risk for developing metabolic syndrome, a lifestyle disease that affects one in every three people in the United States. The hallmark signs of this disease are obesity, elevated levels of blood pressure, cholesterol, blood sugar, and triglycerides. If you have three out of these five factors, you indeed have metabolic syndrome. With pregnancy, the risks could heighten since hormones are unstable. If not addressed in time, this condition increases one’s risk of developing diabetes, cardiovascular concerns, and other chronic diseases. 

Fortunately, though, this disease is reversible. Mothers who consult nutrition experts during their 9-month term can prevent complications and enjoy a healthy pregnancy. This article aims to provide mothers out there with a nutrition guide as to how they can manage multiple pregnancies in the healthiest way possible.


One of the many perks of having multiple pregnancies is the license to eat more. Yes, doctor’s orders! The requirements vary, though, depending on your fitness level. You are required to eat an additional 200-300 calories per fetus if you live a sedentary lifestyle. However, if you are actively training, incorporating at least 4x a week of 30-minute exercises, you need a little bit more. Canada’s Food Guide to Healthy Eating suggests that mothers with multiple pregnancies need to consume around 2200-2600 calories per day. This recommendation meets the nutrient needs of a healthy woman in her second and third trimesters, who expects multiple births.

But while you’re justified the additional calories, it doesn’t mean a free pass to Baskin Robbins every day of the week. Eating well during pregnancy could help your child avoid cardiovascular diseases, hypertension, and type 2 diabetes later in life—so it really matters what you put on your plate. A calorie is simply not a calorie in most foods. Each one has specific attributes that explain why some food causes you to gain more weight than others, even if both foods, in comparison, have the same calorie count. Case in point, 28 pieces of grapes vs. 3 tablespoons of ice cream are both 100 calories but with immensely different nutritional values. It will take a pint of ice cream (around 1000 calories or more) for you to feel full, compared to when you eat a handful of grapes. Since ice cream has a lot of refined sugar, you’ll be most likely hungry again in the next hour or two. Do this daily, and you’ll balloon up in no time, which is what we are trying to avoid.


Not all food is created equal, and the type we choose immensely impacts our blood sugar leading to gestational diabetes. Gestational diabetes is a form of diabetes that occurs only during pregnancy but has affected 1 in 6 births in 2019, according to the International Diabetes Federation. The condition usually disappears after that, but in most cases, those who have developed gestational diabetes are more likely to develop type 2 diabetes later in life. Prevention is paramount. To avoid having metabolic syndrome, pregnant women should follow a healthy weight increment and pay more attention to the food they consume, mainly carbohydrates.

Carbohydrates are one of the macronutrients, along with protein and fats, that our body needs in significant amounts, thus the term “macro.” These foods provide us with energy as we do our daily routines and fuels our brains. Without it, most will experience lethargy and lightheadedness.

Pregnant or not, choosing whole foods that are rich in fiber such as whole grains, steel-cut oats, black rice, or quinoa, and colorful fruits such as berries and apples, and a wide variety of vegetables is vital. It would also be helpful to know the Glycemic Index, which is a food ranking system from 1 to 100 that tells us how quickly carbohydrates are digested as sugar. Low-glycemic carbs, which have a value of 1 to 55, digest slowly, promote satiety, and provide a gradual and sustainable release of sugar into the body. They also have a significant amount of fiber that aids digestion and promotes bowel regularity, which is a concern for most pregnant women.

Nutritionists from the University of Sydney recommend that people consume 80% of their food from this category vs. the refined, ultra-processed, high-glycemic carbohydrates in order to prevent insulin insensitivity. Insulin insensitivity is the result of when a person eats processed carbohydrates regularly, such that the body, its hormones, and their functions are no longer in balance. As a result, the insulin stays in the blood, resulting in consistently elevated blood sugar levels, leading to high blood pressure, triglycerides, and cholesterol levels, which puts the mother and the baby at much higher risk. Moral of the story: eat low-glycemic carbs to prevent insulin spikes.

Protein and Iron

Pregnancy puts your body in a “building” or anabolic mode for the synthesis of your baby’s tissues, so you must get an adequate amount of protein and amino acids. This is not only to ensure that the “building blocks” or the foundation of your child’s system is robust but also to help mothers keep their hunger at bay. Think of your body as a furnace, and the protein is the slow-burning fuel. It keeps the body fuller for longer. Blood volume shoots up by 50% when pregnant, so consuming a sufficient amount of iron-rich protein from lean meat sources aids the development of the baby’s red blood cell supply while also preventing anemia in mothers. Aside from that, iron also helps strengthen the baby’s nerve connections.

How much protein do you need?

Be sure to eat 1 gram of protein per pound of your bodyweight daily. If you are having difficulty knowing how much that would be without a weighing scale, you may use the hand technique to “eyeball” macronutrient needs. A palm-size to a hand-size serving of lean protein is ideal per meal, which should be around 30-35% of your plate. If you are on a plant-based lifestyle, opt for cooked dried beans, lentils, tofu, tempeh, quinoa, dark leafy greens, and chia seeds instead. Aid iron absorption by pairing iron-clad food with food that is rich in vitamin C, such as citrus fruits, peppers, tomatoes, and berries.

Healthy Fats 

Aside from providing our bodies with extra energy, unsaturated fats rich in omega 3s (Eicosapentaenoic acid or EPA, and docosahexaenoic acid or DHA) also give structure to our baby’s cells. They are paramount in the heart, brain, eyes, as well as, immune system development, synthesis of hormones, and absorption of fat-soluble vitamins. Monounsaturated fats are also essential since they are good sources of folic acid that prevent neural tube defects in babies. The American Heart Association (AHA) recommends that expecting mothers should aim for 35% of unsaturated fat during pregnancy. Flax, hemp, sunflower and chia seeds, avocados, walnuts, pine nuts seaweeds, and fish oils (from salmon, mackerel, and sardines) are rich sources of healthy fats. Just make sure that the fish oils that you will be taking meet the GOED standards, which assures that the fish oils are free from carcinogenic PCBs (Polychlorinated Biphenyls).

Folic Acid

Folic acid or folate is an essential B vitamin in pregnancy. So crucial that doctors advise mothers to drink around 400 micrograms daily at least a month before pregnancy. Folate, which is critical in the early stages of pregnancy, ensures that the baby’s brain and spinal cords are developing as expected, preventing birth defects. During pregnancy, expectant mothers are asked to take an additional 200 micrograms during the first trimester, an extra 200-400 micrograms during the second trimester, and an extra 400-800 micrograms in the third trimester. Fresh greens, whole grains, organ meat, oysters, and milk are excellent sources of folic acid. However, since the cooking process somehow degrades the folic acid, mothers are encouraged to take extra supplements that address 100% of the needed requirements.


Calcium is an essential mineral that everyone needs to help maintain healthy teeth and bones, and being pregnant with multiple babies is no exception. Our bodies cannot make calcium on their own, so the best way to get it is to supplement it with at least 1000 mg a day. Without a steady supply, pregnant women may be calcium deprived, with brittle bones, nails, and teeth. Milk, cheese, yogurt, salmon, Bok Choy, legumes, figs, nuts seeds, and dark, leafy greens are excellent sources.


Iodine is one of the most crucial minerals during pregnancy, as deficiency could mean a lifetime of regret. Not having adequate amounts could result in stunted growth, deafness, and severe mental dysfunction and disability. Worst case, it could cause miscarriage and stillbirth.


While it is advised to get most of the nutrients needed during pregnancy from real, whole foods, let’s face it, it’s challenging to get 100% without hacking and gagging because you’re overly stuffed. Pregnant or not, it’s nearly impossible to eat a whole table’s worth of food to get our recommended daily allowance, and with multiple pregnancies, one will need to eat an entire yard more.

This is where supplements get the thumbs up for both doctors and expecting moms. Pop a pill, and you’ve checked the most important task of the day as far as pregnancy is concerned. Not only do these prevent fetal deficiencies, but they also help the mothers feel less nauseated. Here’s what to look for in a prenatal vitamin:

  • 1mg of folic acid
  • 2000 to 2500 mg of calcium
  • 70mg of vitamin C
  • 3 Mg of thiamine
  • 2 mg of riboflavin
  • 20 mg of niacin
  • 10mg of vitamin E
  • 6 mcg of vitamin B12
  • 15 mg of zinc
  • 30 mg of iron for twins, with a limit of 45mg for multiples
  • 150 mcg of iodine
  • 300-500mg of EPA/DHA

Being pregnant with multiples does not mean you need to double your vitamins. However, you need to take an extra serving of your iron and folic acid to ward off deficiencies. And since the pandemic prevents us from going outdoors, adding a 1000 IU/day vitamin D supplement should do the trick.

In the end, expecting mothers of singletons or multiples need to eat right during their pregnancy because their babies’ lives and future health depends on it. By taking these steps and consideration, you, as a mother, can rest assured, knowing that you’ve done everything in your control to ensure a seamless and successful pregnancy.

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