Optimal Nutrition for Improved Twin Pregnancy Outcome

Abstract

Twin pregnancies contribute a disproportionate degree to perinatal morbidity, partly because of increased risks of low birth weight and prematurity. Although the cause of the morbidity is multifactorial, attention to twin-specific maternal nutrition may be beneficial in achieving optimal fetal growth and birth weight. Achievement of body mass index (BMI)-specific weight gain goals, micronutrient and macronutrient supplementation specific to the physiology of twin gestations, and carbohydrate-controlled diets are recommended for optimal twin growth and pregnancy outcomes. The daily recommended caloric intake for normal-BMI women with twins is 40-45 kcal/kg each day, and iron, folate, calcium, magnesium, and zinc supplementation is recommended beyond a usual prenatal vitamin. Daily supplementation of docosahexaenoic acid and vitamin D should also be considered. Multiple gestation-specific prenatal care settings with a focus on nutritional interventions improve birth weight and length of gestation and should be considered for the care of women carrying multiples. Antepartum lactation consultation can also improve the rate of postpartum breastfeeding in twin pregnancies. Twin gestation-specific nutritional interventions seem effective in improving the outcome of these pregnancies and should be emphasized in the antepartum care of multiple gestations. This review examines the available evidence and offers recommendations for twin pregnancy-specific nutritional interventions.

Clinical factors associated with failed trials of labor in late preterm and term twin pregnancies

“…BMI (kg/m 2 ) was calculated using the height and weight prior to pregnancy and at delivery respectively. BMIs were classified according to World Health Organization criteria (overweight and obese > 25.0 kg/m 2 ) and excessive weight gain during pregnancy was based on the 2009 Institute of Medicine (IOM) guidelines, taking into account pre-pregnancy BMI [9,13]. As the IOM did not make recommendations for underweight women (BMI < 18.5) and twin pregnancies in the late preterm, these underweight women were excluded.…”

Nutrition Recommendations in Pregnancy and Lactation

“…One recommendation for macronutrient composition is 20% protein, 40% fat, and 40% carbohydrates. 28,29 It is estimated that a 40% higher-calorie diet may maintain a woman’s nutritional state during a twin pregnancy. Rates of iron deficiency anemia are 2.4-4 times higher in twins than in singletons.…”

Appropriate maternal weight gain in singleton and twin pregnancies: what is the evidence?

“…Based on the work of Luke (2005), they recommended that energy intake should be derived from 20% protein, 40% carbohydrate and 40% fat to deliver a total of 3500 cals/day for women with a normal pre-pregnancy BMI, broadly in line with the IOM recommendations. They endorsed the view that 'total maternal weight gain and the timing of weight gain are crucial for optimal foetal growth in twin pregnancies', with the goal of reducing both the possibility of low foetal birth weight, and excessive maternal weight gain (Goodnight & Newman, 2009). Much earlier, Pederson at al.…”

“…However, the IOM guidelines lead to high recommended total daily dietary intakes for twin pregnancies of 4000 kcal/day for underweight women; 3500 for desirable weight; 3250 for overweight and 3000 for obese women (Luke, 2005). Additionally, the American Dietetic Association (2008) recommended that women carrying more than one baby have increased needs for energy, folate, omega-3 fatty acids, iron, calcium and vitamin D. Goodnight and Newman (2009) proposed an optimal nutrition strategy to improve twin pregnancy outcomes and recommended BMI-specific pregnancy and weight gain goals, micro and macro nutritional supplementation and carbohydrate controlled diets for women expecting twins. They identified the calorie intake for women with normal pre-pregnancy BMI as 40-45 kcal/kg/day, a 40% increase in caloric requirements.…”