Issues for Specific Groups

Multifetal pregnanices

The number of multiple births (e.g., twins, triplets) is increasing in the US, in part because of use of fertility drugs. Multiparity is associated with increased risks for the infant (prematurity, intrauterine growth restriction, low birthweight) as well as for the mother (pre-eclampsia, iron-deficiency anemia).

The literature calls for “optimal maternal nutrition,” however this is not always clearly defined. Weight gain goals and intakes of some nutrients are increased for multiparous pregnancies:

• Weight gain – IOM recommendations are based on pre-pregnant category (see table). Due to the risk of preterm delivery with accompanying intrauterine growth retardation or low birthweight, some suggest a target weight gain of 24 pounds by 24 weeks for twins. (Goodnight and Newman, 2009)
• Energy intake – Needs for a twin pregnancy are approximately 40-45 kcal/kg pre-pregnancy weight. Energy intake should be monitored and varied based on weight gain. (AND, 2014)
• Protein intake – An additional 50 g/day beginning in the second trimester is recommended by the IOM, however since protein is a source of energy, protein may make up 20% of energy intake. (Goodnight and Newman, 2009)
• Minerals – Recommendations for supplementation include 30 mg iron, 2.0-2.5 g calcium, 45 mg zinc, and 1.0 g magnesium per day for multifetal pregancies. (Goodnight and Newman, 2009)
• Vitamins – Recommendations for supplementation include 2 mg vitamin B6, 1.0 mg folate, 500-1000 mg vitamin C, 400 mcg vitamin E, and 1000 IU vitamin D for multifetal pregnancies.(Goodnight and Newman, 2009)