Twins: Special Nutrition and Exercise Needs

There couldn’t be much bigger news than the discovery that you’re carrying twins. It’s natural to feel surprised — and overwhelmed. But don’t worry. A twin pregnancy isn’t all that different from any other pregnancy, just a little more intense. Here are a few things you can do to grow two healthy babies and keep yourself in good shape as well.

Eat even more

Here’s the good news; carrying twins gives you permission to double the amount of extra calories you take in each day over what you usually eat. Instead of adding 300 calories to your diet, as doctors recommend with one baby, you can add 600 extra calories a day. Of course, do your best to also increase the amount of protein, calcium, whole grains, and fruits and vegetables. Your goal is to give birth to babies with healthy birth weights — and eating a high-protein diet with all food groups covered increases these odds. Some insurance plans may cover nutritional counseling for women pregnant with twins; check with your practitioner or health plan manager.

Watch your weight gain

Unfortunately, doubling your extra calories does not mean doubling your weight gain. Unless you were underweight or overweight before your pregnancy, doctors consider a weight gain of 37 to 54 pounds healthy for a woman carrying twins, which isn’t so much more than the 25 to 35 pounds recommended for a single pregnancy.

The reason is that carrying twins already increases the chance of complications such as premature labor and undergoing cesarean delivery, and gaining too much weight simply adds to this likelihood. The average twin pregnancy lasts only 35 weeks rather than 40, and twins tend to be born with considerably smaller birth weights (averaging 5.5 pounds.) Your doctor or midwife will want to make sure you carry your babies as close to full term as possible, and that they reach the highest possible birth weight.

And it’s not just how much you gain, but when you gain that’s important. Aim to put on at least a pound a week starting as early in your pregnancy as possible. Studies show that gaining at least 24 pounds by the 24th week of a twin pregnancy helps reduce the risk of having preterm and low-birthweight babies.

If, on the other hand, you were significantly underweight or overweight before becoming pregnant, talk to your doctor or midwife about how much weight you should gain.

Take prenatal vitamins

According to the American Society of Reproductive Medicine, most doctors recommend increasing your vitamin dosage by 50 to 100 percent. But doctors disagree on this point because some vitamins, Vitamin A, for instance, can cause birth defects in too high a dose. It’s best to discuss vitamins with your doctor. A good-quality prenatal vitamin, plus some extra calcium may be all you need.

Don’t skimp on iron

The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women take a low-dose iron supplement of 30 mg a day. And many experts consider this even more important for women carrying twins, who are at increased risk for iron deficiency anemia. You can also increase your iron intake from food by eating plenty of lean red meat and poultry and green leafy vegetables like spinach. One of the easiest sources of iron is blackstrap molasses, which has 3.5 mg of iron in one tablespoon.

Drink plenty of water

Staying well-hydrated helps prevent you from getting constipation, hemorrhoids, and urinary tract or bladder infections. And it can help prevent edema swelling in your feet and ankles. All pregnant women should drink at least six eight-ounce glasses of water a day; if you can drink even more than that, so much the better. Carry a big water bottle with you in your car or purse, and keep a big glass full of water on your desk when you’re at work.

Be prudent with exercise

How much and how long you can exercise while carrying twins depends on your health and on your doctor’s comfort level. During the first trimester it is probably fine to continue your favorite form of low to medium-impact exercise, but your practitioner will probably tell you to take it easy once you’re into the second trimester.

According to the American Society of Reproductive Medicine, experts advise avoiding strenuous activity starting around 20 to 24 weeks. Again, this is because you already have a risk of premature labor, so your doctor will want you to steer clear of anything that could contribute to early contractions. Lower impact exercise such as swimming or walking may be fine as long as you feel comfortable, but it will depend on how well your body is handling your pregnancy and whether you have any other risk factors.


March of Dimes. Multiples: Twins Triplets and Beyond.

American Dietetic Association. Nutrition and lifestyle for a healthy pregnancy outcome.

American Society for Reproductive Medicine. Patient’s Fact Sheet: Complications of Multiple Gestation. August 2001.

American Society for Reproductive Medicine. Multiple Pregnancy and Birth: Twins, Triplets, and Higher Order Multiples, A Guide for Patients.

March of Dimes. Vitamins and Minerals.

American Family Physician. CDC issues guidelines for prevention, detection and treatment of iron deficiency.

Swedish Medical Center. Good Food Sources of Iron.

National Women’s Health Information Center. Pregnancy and a Healthy Diet.

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