Putting Research Into Practice: What Works For Healthy Multiple Pregnancies

Barbara Luke, ScD, MPH. Presented at the International Society for Twin Studies, Florence, Italy, March 2012
  1. The Basics
    • No smoking (including anyone in the household)
    • No alcohol use
    • Reduce stress at work/home
    • Adequate rest/sleep
  2. Influence of Obstetric History
    • Prior, full-term, well-grown infant: adds ~two weeks
    • Prior preterm, low birthweight, or preeclampsia: increased risk in current pregnancy
  3. Pre-Pregnancy Weight-for-Height
    • If underweight (Body Mass Index [BMI] < 20), pattern of gain is more important
    • If overweight/obese, quality of the diet is more important
  4. Pattern of Gestational Weight Gain
    • Weight gain goals by 20 and 28 weeks
    • Range by maternal BMI (overweight recommendations are the lower numbers, underweight are the higher numbers)
  By 20 weeks By 28 Weeks
Twins 15-35 lbs 23-51 lbs
Triplets 30-40 lbs 46-60 lbs
Quads/Quints 40-50 lbs
60-70 lbs
 
  1. Healthy Diet
    • Protein and carbohydrate together at every meal and every snack
    • Eat every 3-4 hours, more often if hungry or pregnant with triplets or quads
    • Dairy bedtime snack (digested slowly)
    • Adequate hydration (urine should be pale)
  2. Selected Supplementation
    • Folic Acid, 4 mg/day
    • Calcium, 1-2 g/day
    • Magnesium 400-800 mg/day
    • Zinc, 15-30 mg/day
    • Vitamin D, 25-50 mcg/day (2000-4000 IU)
    • Omega-3 fatty acids, 1000 mg/day or more
  3. Timing of Delivery
    • For twins: 37-39 weeks
    • For triplets: 34-36 weeks
    • For quads & quints: 32-34 weeks