Meeting Your Nutritional Goals During a Twin Pregnancy

Contributors: Kelley Bradshaw, MS, RD, LDN, CDCES, is a senior dietitian and outpatient clinical manager in the Nutrition and Wellness Service at Brigham and Women's Hospital. Carolina Bibbo, MD, is a maternal-fetal medicine specialist and director of the Comprehensive Care Center for Multiples at the Brigham. Lucy Graves, MSN, RN, CBS, is a nurse in the center.

What's the number 1 nutritional challenge of a twin pregnancy? According to Kelley Bradshaw, it's addressing the need to take in more calories and protein.

"But it's not just a matter of eating more. It's not that simple," she cautions. "Many patients in the first trimester experience nausea and vomiting, so eating can be difficult."

Meeting your nutritional goals is essential to keep yourself and your babies healthy throughout your pregnancy. That's why at the Comprehensive Care Center for Multiples, every patient is encouraged to meet (virtually) with a registered dietitian during the first trimester. It's important to have a plan so that you and your babies get the necessary nutrients in the months ahead.

The Power of Protein

The following are general nutritional recommendations for twin, triplet and higher-order pregnancies:

  • Protein: 100 grams per day.
  • Calories: An increase of 300 calories per day per baby in the first trimester (see below for more details).
  • Iron: 30 milligrams per day (first trimester) and 60 mg per day (second and third trimesters) to prevent anemia (lack of healthy red blood cells). Iron is included with most prenatal vitamins, though extra supplements may be needed.
  • Folic acid: 1 mg per day to prevent birth defects of the brain, spine or spinal cord. Most prenatal vitamins have 0.4 to 0.8 mg of folic acid, so extra supplements may be needed.

Protein is crucial for your babies' growth in the womb. Animal-based sources of protein include dairy, eggs, poultry, red meat and fish. According to Bradshaw, the body can absorb and use the protein in these sources better than that in non-animal sources.

Some patients have questions about whether they can safely eat fish due to concerns over mercury. Most fish and shellfish have traces of this naturally occurring element. In large doses, it can harm a baby's nervous system. However, plenty of fish are lower in mercury and safe to eat in smaller portions. For instance, Bradshaw recommends having 12 ounces or less of fully cooked fish such as salmon, cod, trout or mahi-mahi two or three times a week.

Of course, some pregnant patients either choose not to eat or cannot tolerate animal-based foods. Instead they may turn to plant-based sources of protein such as tofu, beans, legumes, nuts and seeds. Protein bars and shakes are also good options. You can even make your own protein shakes, adding vegetables, healthy fats (such as avocados, nuts and seeds) and/or unflavored peptide supplements.

Don't Count Calories

Calories are critical to helping you and your babies gain weight during pregnancy. With twins or triplets, you should increase your daily intake by 300 calories per baby in the first trimester, 340 calories per baby in the second trimester and 452 calories per baby in the third trimester. Your dietitian will make personalized recommendations on calories based on factors like your pre-pregnancy weight.

Bradshaw stresses that while you shouldn't count calories, you should try to take in calories from healthy foods. Having food with lots of calories like pizza or potato chips is fine once in a while. But as a long-term strategy for your pregnancy, you should look to foods with nutrients to help your babies grow. Fruits, vegetables and nuts are just a few of the many examples.

Many pregnant patients, however, experience nausea, vomiting and loss of appetite — especially in the first trimester. This can make it hard to eat the protein- and calorie-rich foods that you and your babies need.

Fortunately, there are workarounds. Your care team can share tips on how to settle your stomach, such as:

  • Taking medications to prevent nausea and vomiting
  • "Grazing" throughout the day — eating smaller snacks rather than having big meals
  • Drinking ginger tea or cold water with a little lemon juice
  • Avoiding rich, creamy or greasy foods

"It's hard to find nutritious foods to eat in the first trimester," Lucy Graves says. "Most of our patients crave things like potato chips and bread. Whatever it takes to get you through the first trimester, we will work with you."

"Many patients actually lose 5 to 10 pounds in the first trimester," Bradshaw adds. "That's fine, as long as you gain enough weight later on."

By the second trimester, the issue of keeping food down usually goes away. At that point, with your appetite back, you can focus more on meeting your nutritional goals.

A Common-Sense Approach to Weight Gain

How much weight should you gain over the course of a twin pregnancy? The answer depends in part on your pre-pregnancy body mass index (BMI) and weight. BMI is a measure of body fat based on your height and weight.

Below are the Institute of Medicine's recommendations for weight gain during a twin pregnancy.

Pre-pregnancy BMIRecommended Weight Gain
<18.5 (underweight)No recommendation due to insufficient data
18.5–24.9 (healthy weight)37–54 pounds
25.0–29.9 (overweight)31–50 pounds
≥30.0 (obese)25–42 pounds

"Some patients are surprised by how much weight they should add, but keep in mind that you're carrying two placentas, extra fluid and two babies," Bradshaw says.

Although weight gain understandably can be a sensitive matter, Dr. Carolina Bibbo urges patients to take a "common-sense approach." That is, recognize that excessive weight gain is not healthy for you or your babies, but try not to obsess over your weight on a daily basis.

"I don't follow the patient's weight so strictly at each visit," Dr. Bibbo says. "Everyone gains weight differently and at a different pace. If you're eating nutritious meals with plenty of healthy, dense snacks, you're doing things right."

Bradshaw agrees with that assessment. "Outside of the increased protein and calories, the recommendations we're making — getting enough fiber, fruits, vegetables, whole grains and calcium while limiting unhealthy foods — are the same recommendations we're making to people who aren't pregnant."

Learn more about the Comprehensive Care Center for Multiples.

Related Articles:


We understand that you may have concerns and want to assure you that we are steadfast in our commitment to safely providing the care you need. Our experts in the Center for Multiples are available to connect with you in person and with Virtual Visits. To request an appointment, call 617-732-5130 or submit the form below.

Request an Appointment

Patient Information

Please verify that you are not a robot by clicking on the Request Appointment

Learn more about Brigham and Women's Hospital

For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.

About BWH