Subspecialty Care

Families expecting multiples (twins, triplets or higher-order multiples) benefit from care that is geared toward their specific needs and challenges. That's why the Brigham's Comprehensive Care Center for Multiples offers subspecialty care that includes genetic counseling and nutrition services.

Genetic Counseling

Genetic counselors are medical professionals who provide parents and families with information on the implications and inheritance of genetic disorders. Having this information can help you make informed reproductive decisions.

At the Brigham, our genetic counselors provide comprehensive assessment and counseling services before, during and after pregnancy. Women who are at an increased risk of having a pregnancy with birth defects, chromosomal abnormalities or inherited diseases — including women who are expecting multiples (twins, triplets or more) — may benefit from these services.

Every patient at the Center for Multiples meets with a genetic counselor who specializes in pregnancies with multiples. The genetic counselor will inform you about the testing options that are best at determining risk of a genetic condition in multiples and help you decide on a testing plan.

Fetal Therapy Program

Sometimes one or more babies in a multiple pregnancy require treatment before birth. In these cases, the Brigham's nationally renowned Fetal Therapy Program is ready to help. The program offers services and therapies for a growing number of genetic disorders. Team members work closely with maternal-fetal medicine specialists and neonatologists in our Department of Pediatrics to deliver coordinated, ongoing care.

The Fetal Therapy Program is part of the Brigham's Center for Fetal Medicine and Prenatal Genetics, which provides compassionate, comprehensive assessment and treatment of inherited conditions and a wide range of fetal diseases.

Nutrition

Being pregnant with multiples creates unique dietary challenges. You may experience nausea, loss of appetite or feelings of fullness, for example. However, it is important to take in extra calories, vitamins and minerals to satisfy the growing nutritional needs of you and your babies.

In order to make sure you are eating a healthy diet, the Center for Multiples schedules a nutrition consult early in your pregnancy. You will meet with a nutritionist who specializes in working with women expecting multiples. This is a great opportunity to discuss your nutritional goals and potential nutritional complications to watch out for.

You will leave the consult with a thoughtful plan to ensure you and your babies are getting all necessary nutrients during your pregnancy.

Nutritional Recommendations

The following are some general recommendations on nutrition for a multiple pregnancy:

• Increase your protein intake to 100 grams per day. You can meet this goal through your regular diet or by supplementing your diet with protein shakes and/or protein bars.
• Increase your dietary intake by about 300 calories per day per baby that you are carrying. High-protein shakes are a good option for this because of their high nutritional value.
• In order to prevent anemia (lack of healthy red blood cells), the Society of Maternal-Fetal Medicine recommends taking 30 milligrams of iron (included with most prenatal vitamins) daily during the first trimester and 60 mg daily thereafter.
• In order to prevent defects of the brain, spine or spinal cord, the Society of Maternal-Fetal Medicine also recommends taking 1 mg of folic acid daily. Since most prenatal vitamins have 0.4 to 0.8 mg of folic acid, extra supplementation is necessary.

Women expecting multiples need to gain more weight than women carrying a single baby. The total weight gain recommended will depend on your body mass index and the number of babies you are carrying. Body mass index, or BMI, is a measurement of body fat based on your height and weight.

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

A Common-Sense Approach to Weight Gain

Pregnant women vary in their patterns of weight gain. Some women gain more at the beginning and some more at the end. Many struggle with concerns about weight and body image.

At the Center for Multiples, we believe if you eat healthily and follow the guidelines that our nutrition team recommends, you will do just fine. We take a common-sense approach to weight gain and look at the overall trend during pregnancy. If you are concerned that you are gaining too little or too much weight, speak up — and we will do the same. If you do not want to be weighed, we will honor that request.

As with all aspects of your care with us, managing weight gain is a team effort. We are here to help and support you in experiencing a healthy, happy pregnancy with the best possible outcome for you and your babies.