What and How Much to Eat When Pregnant With Multiples

By Petra Colindres, MA, RDN/LD, IBCLC, CPT

multiples nutrition.pngAre you pregnant with twins or more? As they say, it's double the blessings and later on, double the trouble! But is it double the nutrition efforts and calories? People pregnant with multiples often wonder just how many calories they should be eating. Is it double the amount of food? Double the weight gain? What about prenatal vitamins? 

Ideal Weight Gain

Luckily, there are solid answers. According to Academy of Nutrition and Dietetics, women who are pregnant with twins with a typical pre-pregnancy weight (pre-pregnancy BMI of between 18.5-24.9), total weight gain should be between 37-54 lbs. total. For women with a higher than average weight prior to pregnancy (pre-pregnancy BMI 25-29.9), the total weight gain should be between 31-50 lbs. Women with a pre-pregnancy BMI greater than (or equal) to 30 should have a total weight gain of around 25-42 lbs.


Great, so we know how much weight to gain, but what does that mean in terms of how much to eat? How many calories a day do moms-to-be with multiples need in order to gain the weight needed for a healthy pregnancy? Using the classifications we used earlier, for women with typical BMI (between 18.5-24.9), the estimated need is 40-45 calories per kilogram of pre-pregnancy weight, or around 3,000-3,500 calories per day. Women with a BMI greater than 25 need 30-35 calories per kilogram based on pre-pregnancy weight, or about 2,700-3,000 calories per day. To ensure adequate intake of macronutrients, your diet breakdown should be about 20% protein, 40% fat and 40% carbohydrates. There are many apps you can download to see the breakdown and make sure you’re hitting the ratios that are best for you and baby.

Protein Sources

The ideal protein sources for a healthy pregnancy include lean meat, fish, eggs, dried beans, nuts, dairy, and soy products. Lots of the protein foods like meats, fish, beans, and tofu have the added bonus of being high in iron, which is a benefit for women who are pregnant with twins since they are at higher risk of being anemic. Iron requirements do increase drastically (from 27mg to 60mg per day) when a person is carrying twins. Iron is especially important during pregnancy as iron deficiency is associated with increased risk of preterm birth and low birth weight. 


Fat is an importance source of energy and is needed to help the body to absorb fat-soluble vitamins. The World Health Organization recommends 300-500mg of Omega-3s be included in daily fat consumption to help promote fetal and early childhood mental development. Good food sources for Omega-3s include fish like anchovies, catfish, codfish, salmon, herring, mackerel, tuna, and halibut; organ meat, like liver; fish oil; and smaller amounts can be found in poultry and egg yolks. 


Carbohydrates are needed during pregnancy because they are the main source of fuel for the body and brain. However, not all carbohydrates are created equal. Complex carbohydrates are those that are best for a growing baby and include high fiber foods that are preferred due to their ability to help stabilize blood sugar. Good sources of complex carbs include whole grains, green vegetables, starchy vegetables, and beans. 


Last, but not least, but what about prenatal vitamins? Even though you're carrying more than one baby, just one prenatal vitamin is recommended, with careful monitoring by your OBGYN to make sure that your micronutrient ranges are within normal values.

Wishing you a happy, healthy, and nutritious pregnancy!

pet.jpgPetra Colindres is a Family Dietitian and Lactation Consultant with a passion for infant nutrition and prenatal education, valuing the importance of the first thousand days of an infant’s life (from conception to 2 years) to be the standard for future successful health outcomes. Petra owns Nutrition by Petra, a pregnancy and early childhood nutrition consultation practice that provides at-home lactation assistance and pediatric nutrition support. Petra’s hobbies are running/working out, teaching cooking classes around the state, and playing with her first child Bodie. Follow Petra on Twitter @PetraNutrition, on Facebook or on instagram @nutritionbypetra to see some of her favorite baby meals. You can also email her at nutritionbypetra@gmail.com.

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