Nutritional Considerations for Twin Pregnancy
About 3.3% of mamas have a twin pregnancy each year, and this number has been on the rise. The twin birth rate has risen 70% since 1980. Higher order multiples (triplets and quadruplets) happen far less frequently (less than 1% of births per year), but the birth rate for triplets and other higher-order multiples has also risen in recent years.
There are several reasons for this increase, largely due to an increase in incidence of the root cause of multiples pregnancy. Beyond heredity, multiples pregnancies are more common in women over the age of 30. Since women have been marrying and starting families later and later, pregnancy beyond 30 has become increasingly common. Another cause for multiples pregnancy is the use of ovulation stimulating medicines and assisted reproduction, such as in vitro fertilization (IVF), and an increasing number of women have been taking advantage of the technological and scientific advances in fertility support in recent years. This type of support was far less accessible even just a generation ago.
But twin pregnancy brings higher risk of pregnancy complications like preterm labor, low birth weight, and intrauterine growth restriction (IUGR).
Ensuring adequate nourishment throughout your twin pregnancy is one way to lower the risk of these complications and increase the likelihood that you’ll give birth to two (or more!) healthy babies! So how do nutrient needs change for a twin pregnancy? We were curious too, so we dug into the research. The following nutrients are needed in higher amounts than in singleton pregnancies:
Overall caloric needs increase substantially in a twin pregnancy as compared to a singleton pregnancy, but research has shown that the macronutrient makeup of caloric intake can impact the health of the fetuses and the length of term they are carried. Ensuring adequate protein intake can help reduce the risk of low birth weight, and inadequate amino acid availability can restrict placental growth, further limiting nutrients to the baby.
For optimal pregnancy outcomes, it is recommended for mamas of both singletons and twins to consume 20-25% of their daily calories from Protein. This means that if you’re eating 2,500 calories per day, you need 125-156 grams of protein. If you’re eating 3,000 calories per day, you need 150-187 grams of protein.
An easy way to add protein to your day is with our Prenatal Collagen. Not only is it an excellent source of protein and amino acids that are so essential to your growing baby and placenta, it also feels less filling and heavy than other sources of protein, which is particularly helpful when your growing babies leave little space for food in your stomach. Each serving contains 14 grams of Protein, so simply adding it to your liquids (hot or cold) three times per day gets you 42 grams of Protein - well on the way to your daily goal.
We know that Folate is critically important for the development of baby’s neural tube. So if there are two neural tubes, do we need more? The answer is yes.
While 600mcg DFE is recommended for mamas carrying one baby, 800-1000mcg DFE is recommended for mamas carrying multiples.
Our prenatal contains 918mcg DFE of Folate, well within the recommended range.
Iron deficiency is a common nutritional deficiency in twin pregnancies, as Iron is critically needed to help support the significant increase in blood volume during pregnancy. Iron deficiency has been associated with preterm birth and low birth weight.
In a woman who enters pregnancy with adequate Iron levels, it is recommended to consume 27mg of Iron daily in a singleton pregnancy. Various studies have suggested that this number increases by 1.8-2x daily for a twin pregnancy. This is a substantial increase from the requirement for a nonpregnant menstruating woman of 18mg daily. Even for meat-eating mamas, 48mg of Iron can be tough to achieve through food alone (a 3 oz. serving of beef only contains 2.2mg of Iron). Ideally you can get your Iron levels checked throughout pregnancy, but if not, tracking Iron intake and supplementing as necessary would benefit both you and baby. Check out our dosage chart for more guidance. While it is designed with requirements for a singleton in mind, it can be used as a minimum recommendation for your twin pregnancy.
As too much Iron can be just as detrimental as too little iron, we opted to leave the Iron out of our Prenatal Multi and instead offer it separately, in individual doses of 13.5mg each. While supplemental Iron is notorious for being difficult on digestion and causing constipation, our Prenatal Iron is in the gentle and well-absorbed form of Ferrous Bisglycinate. Three of our Prenatal Iron pills would get you near your minimum daily requirement of Iron at 40.5mg.
Calcium is essential to help develop the skeleton of a baby, and in a twin pregnancy, you’re building two skeletons, not just one. If your Calcium intake is not sufficient, the body will pull stores of calcium from your bones, leaving you with decreased bone density. But it's not just bone density to worry about if this happens. When your bones release Calcium, they can also release lead stored in your bones. Lead is toxic, particularly to the brain and nervous system, so this presents a great hazard to your developing babies. Studies have shown that women who have adequate Calcium intake or supplementation have lower levels of lead in their cord blood and breastmilk.
In addition to bone development, Calcium has also been shown in numerous studies to help reduce the risk of pregnancy-induced hypertension and preeclampsia, both large risk factors in a twin pregnancy.
A singleton pregnancy requires 1,000mg of Calcium daily, and for twin pregnancies, this amount doubles to 2,000mg daily.
Our Prenatal Multi contains 400mg of Calcium Malate. If you eat dairy, you can likely meet your remaining needs through food. A serving of milk contains 250mg, while cheese and yogurt contain between 200mg and 350mg per serving. Calcium is available in plenty of non-dairy sources as well, like sesame seeds, kale, broccoli, beans, and fish with bones, but the amounts are lower per serving. Therefore, if you cannot tolerate or choose to avoid dairy, mamas of multiples may benefit from supplementing with extra Calcium in addition to our Prenatal Multi. Look for well-absorbed Calcium Malate.
In addition to supporting over 300 enzymatic reactions in the body and helping to alleviate common pregnancy woes like muscle cramps, nausea, and heartburn, Magnesium lowers the risk for preterm labor by relaxing the smooth muscle of the uterus. It has also been shown to be effective in treating preeclampsia and preventing its progression to eclampsia, a more severe life-threatening condition that can cause seizures.
It is recommended to consume 800mg of Magnesium daily throughout your twin pregnancy.
Our Prenatal Multi has 400mg of Magnesium Bisglycinate, the optimal form and a far-higher dose than most prenatal vitamins. Both Magnesium and Calcium, in their proper forms, are quite bulky nutrients, making it difficult for prenatal vitamins to include meaningful amounts in 1-2 pills or gummies. Our Prenatal Multi powder allows us to dose these nutrients at optimal levels, though mamas of multiples may benefit from even more.
While many healthy foods like nuts, seeds, and leafy greens contain Magnesium, it is estimated that only approximately 30 to 40% of Magnesium consumed through food is absorbed. Therefore, an additional Magnesium supplement up to 400mg is wise. As Magnesium can support sleep and relaxation, we recommend taking your additional dose in the evening before bed. You can also take Magnesium transdermally, or through the skin by using oil sprays, lotions, or epsom salt baths. While this can be harder to measure exactly how much you’re getting, it can be easier to take than a pill and a nice way to wind down at the end of the day.
Low dietary intake of Zinc has been linked to an increased risk of low birthweight and preterm delivery, while proper Zinc supplementation has been shown to improve fetal growth and nervous system development and to support immunity.
Zinc needs are elevated in a twin pregnancy. It is recommended to take 30mg of Zinc daily.
Our Prenatal Multi has 25mg of Zinc Bisglycinate. If you are a meat eater, chances are you get the additional 5mg of Zinc needed through diet. A 3 oz. serving of beef has about 5mg and a 3 oz. serving of chicken has about 2.5mg. Many other foods like beans, oats, cheese, almonds, cashews, chickpeas, yogurt, milk, and pumpkin seeds also have 1-2 grams of Zinc per serving. If you do choose an additional supplement, opt for Zinc Bisglycinate, as this form is well absorbed and used by the body.
We know that Omega-3 is needed by baby for fetal brain development and mama for hormonal and mood balance as well as cardiovascular health, but the need for Omega-3 increases in twin pregnancies. In fact, Omega-3 has been shown to reduce inflammation and the risk for premature delivery.
While 300-500mg of Omega-3 is recommended daily in a singleton pregnancy, this amount increases to 1000mg daily in a twin pregnancy.
Our Omega-3 Powder has 450mg of Omega-3 per packet and is sourced from cleanly and sustainably-grown vegan algae. It absorbs 5x better than standard fish oil pills (meaning you fully absorb it!) and is protected from oxidation, thanks to liposomal delivery. The dose can be safely and easily doubled for twin mamas. Note that it is backordered at the time we’re writing this, so we shared a few alternative options in this post. You could also meet your Omega-3 needs through food, by eating fatty Omega-rich fish like salmon (1200 mg/3 oz serving), sardines, or mackerel. While most mamas don’t eat these quantities of fish daily, and particularly when potential heavy metal content becomes a concern in pregnancy, it is certainly safe to supplement on top of daily fish consumption.
Vitamin D helps the body to absorb and retain other minerals, including calcium, critical for mama’s bone density and the developing skeleton of the babies. Vitamin D also supports immunity, which is otherwise lowered during pregnancy, and protects against other infections especially risky to pregnancy, like bacterial vaginosis. Research has also shown that Vitamin D can help protect against prematurity and preeclampsia.
There is quite a bit of controversy over optimal Vitamin D levels, and that is partially because women go into pregnancy at very different starting levels. While the RDA is 600 IU, many experts suggest a range of 1,000 to 4,000 IU daily. Research has shown that the best pregnancy outcomes are associated with a maternal blood level of 25-hydroxy Vitamin D between 40 and 60 ng/ml, so targeting a daily supplementation amount that keeps you within this range is ideal. Women carrying multiple pregnancies with a level within this range were shown to have a significant reduction in the risk of preterm birth.
Our Prenatal Multi has 4000 IU of Vitamin D, which our research showed was a safe amount to maintain and even boost serum Vitamin D levels. Of course, we highly recommend getting tested at least once during pregnancy, but if testing isn’t available to you, our dosage will provide an effective dose to maintain or even slightly raise your levels.
Twice as Nice
We dosed our prenatal supplement line to contain optimal amounts of the nutrients that mamas need to support a healthy body and a healthy baby. Since our dosing is so generous, but also very safe, our Prenatal Multi gets you well on your way to many of the amounts recommended for twin pregnancies.
You might be wondering, can I double up on the dose of Needed's Prenatal Multi? We don't recommend doing this, as you don't need double of every nutrient every day. It's better to supplement for only what you need, like extra Magnesium or Calcium, as you don't want to overdo it on all nutrients. Since we’ve dosed our Omega 3 powder and Iron separately, these are easy to double up on, and we encourage you to do so as needed. Our Collagen is also offered separately and absolutely safe to consume multiple times per day.
As always, we hope you feel empowered with this information so that you can feel confident in your food and supplement routine, advocate for yourself and your baby, be aware of any potential deficiencies or complications, and reach out to your provider with any questions or to request blood work. You’ve got this, mama!
Luke, Dr. Barbara D., Eberlein, Tamara, Newman, Dr. Roger B. When You’re Expecting Twins, Triplets, or Quads: Proven Guidelines for a Healthy Multiples Pregnancy.
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