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On this episode, we tackle the problem of hyperemesis in multiple pregnancies and explain how to maximise your nutrition when you’re too ill to keep anything down, or there’s simply no room left for food.
Maternal-Fetal Medicine Specialist Associate Professor Craig Pennell explains what happens to your body when you’re supplying nutrients to more than one baby at a time, and what supplements are required to ensure your vitamin and mineral needs are catered for.
Pregnancy Dietician and Nutritionist Jessica Ruescher offers some practical advice on the types and amounts of foods you’ll need to eat, to maintain adequate weight gain during your pregnancy.
Also, twin mum Elyse Jamieson and I talk about our experiences with hyperemesis, while mum of quadruplets Jannelle Snaddon shares her struggle with nutrition towards the end of her pregnancy when she was running out of room for food.
As a woman carrying more than one baby, your energy and protein requirements are dramatically increased. This is because your resting energy expenditure is much greater than that of a woman carrying a singleton. What this means is that due to the increased maternal tissue you’re carrying you'll burn more calories at rest.
And, this, of course, affects your vitamin and mineral levels, which have a significant impact on the growth and development of your babies.
Maternal-Fetal Medicine Specialist Professor Craig Pennell explains that vitamin supplementation is a lot more important in twins than in singletons, and it’s actually not for the baby it’s more for the mother. He says the babies will take what they need from the mother almost always, which leads to the mother losing calcium from her bones. She will also lose iron because she’s making an extra litre-and-a-half to two-litres of maternal blood, plus two placentas, plus two baby blood volumes, all of which uses up iron.
Professor Pennell advises all women carrying multiples to take a good pregnancy multivitamin, more folate than normal, iron, and calcium in a preventable manner at the very beginning of their pregnancy.
“When the vast majority of women become iron deficient in pregnancy, and when we know it’s going to happen to all twins, the best thing to do is to start supplementing early,”
“That way if you get side effects from the iron, missing a few days here and there isn’t an issue when you’re looking at it over a seven-or-eight-month period,”
“Whereas if you’re trying to cram all of your iron in at 30-weeks to have it fixed before your delivery then it becomes a much bigger problem,” he says.
It’s no secret that vomiting and hyperemesis are much more common in multiple pregnancies because you have two, three, or even four times the pregnancy hormones.
“Vomiting and hyperemesis are much more common in multiple pregnancies because you have two, three, or even four times the pregnancy hormones.”
~ Maternal-Fetal Medicine Specialist Professor Craig Pennell~
Professor Craig Pennell tells us that the first trimester is usually the most challenging and the best advice, if this is the case, is to keep down whatever you can and not be too worried about it, with water being the most important thing.
Hypnobirthing Practitioner and Birthing Doula Elyse Jamieson was hospitalised with hyperemesis in her first trimester and struggled to eat anything substantial for the first 18 weeks of her twin pregnancy. She even had a short stay in the hospital to get some intravenous fluids in.
“The main thing for me was managing my life with the hyperemesis,”
“I was fairly well bedridden for a large chunk of my pregnancy,” admits Elyse.
Elyse says that simply keeping hydrated and trying to eat any food was a struggle and there was a period where she couldn’t even keep water down.
“I’m the kind of person who eats organic food and eats the rainbow of vegetables and things but I couldn’t stomach most things for weeks at a time,” says Elyse.
Despite being quite a small person Elyse didn’t lose any weight during the height of her hyperemesis. And, when she was able to eat again she says managed to maintain consistent weight gain by listening to her body and eating her usual diet.
Carbohydrates and Protein
Mum of quadruplets Jannelle Snaddon says despite being pregnant with quadruplets she didn’t struggle with eating as much as she expected.
“The first two trimesters I found that I needed heavy foods, so I ate a lot of carbohydrates, I ate a lot of protein because I was told that that was good to give the babies a chance,”
“I was definitely gonna have them early, so everything that I could give them was the best for them growing,” says Jannelle.
“The first two trimesters I found that I needed heavy foods, so I ate a lot of carbohydrates, I ate a lot of protein because I was told that that was good to give the babies a chance.”
~Mum of Quadruplets, Jannelle Snaddon~
Jannelle believes eating all the heavy foods at the beginning of her pregnancy helped ward off the intense sickness that most other mums of multiples struggle with early on in their pregnancy.
Heading towards the end of her pregnancy, Janelle went inpatient at 26-weeks’ gestation and the nurses started making her protein drinks to get enough nutrition in.
“The hospital also had a resource juice drink, which was protein based, which made it a lot easier to fit everything in there amongst the four bambinos,” says Jannelle.
When there is no room for food
According to Professor Pennell the critical time for weight gain in multiples is from 16-to-30 weeks, and then it tends to plateau off at the end.
“The problem is once you get past about 28-to-30 weeks there’s no room left in your abdomen, so even eating can start to become difficult,” he says.
The Importance of Weight Gain in Multiple Pregnancies
The other thing which some women struggle with is the concept of weight gain in pregnancy. In twin pregnancies, there’s very good data to show that the mother needs to gain 12-15 kilograms across the pregnancy, otherwise they will get growth restriction in their babies, according to Professor Craig Pennell.
“For some women, weight gain in pregnancy is very easy,”
“For other women, such as athletes or those who have jobs that require them to have a particular appearance, the concept of gaining 15 kilos goes against their habits and they will struggle greatly with the concept of gaining weight,”
“For those women who struggle to gain weight, protein supplement drinks, sustagen, or protein milkshakes between meals can often help," says Professor Pennell.
“In twin pregnancies, there’s very good data to show that the mother needs to gain 12-15 kilos across the pregnancy otherwise they will get growth restriction in their babies.”
~Maternal Fetal Medicine Specialist Professor Craig Pennell~
Where is the weight being gained?
By the end of your pregnancy with twins you’re looking at:
Two extra litres of blood - 2kgs
a placenta – 1 kg
Two babies – 2.5kgs each
Breast tissue – 2kgs
Total – Approximately 10kgs
“If you’re gaining less weight than 12 kilos you’re actually losing your own weight and that usually comes from muscle,”
“Diet in pregnancy is very complex so if there are any issues, it is worth seeing a good dietician,” suggests Professor Pennell.
The Consequences of Inadequate Weight Gain in Multiple Pregnancies
Professor Pennell explains that the harm of inadequate weight gain during multiple pregnancies almost exclusively is that the babies fail to reach their optimal weight.
“If you’re a small baby that’s been small from the start, and you’re born small, you’ll be small later on, and that’s okay,”
“If, however, you’re the child of two six-foot parents, and you don’t reach that potential, then your body is set up for a hostile environment and you’re more likely to get high blood pressure, diabetes, obesity, stroke, and all of the significant adult diseases,” warns Associate Professor Pennell.
What you need to know about nutrition and weight gain in your multiple pregnancy
There are no specific dietary guidelines for multiple pregnancies, however, as Pregnancy Dietician and Nutritionist Jessica Ruescher from Essence of Eating explains, the calories/energy needed each day depends on your pre-pregnancy weight, genetic makeup, and cultural background.
Jessica says as a rough guide, recommendations for total calorie intake per day would be about 3500 calories or 14,700kJ, which is a lot of food.
“You need to eat FIVE serves of vegetables/salad per day, TWO serves of fruit per day, eight-and-a-half serves of bread and cereals per day, three-and-a-half serves of protein per day, and two-and-a-half serves of dairy or dairy alternatives per day.
This is what that looks like:
A bowl of rolled oats with cow’s milk, milk alternative, or yoghurt with nuts seeds and dried or fresh fruit.
Two pieces of wholegrain toast with egg/avocado/ tomato/cheese.
A piece of fruit with fruit toast or a small tub of yoghurt.
Chicken, tuna, beef, tofu, or lentil patties with salad on a multigrain roll.
Roasted vegetables/salad with nuts, cheddar cheese, brown rice, or barley. Add extra virgin olive oil as a dressing to taste.
Wholegrain Vita Weats with peanut or almond butter and banana.
Veggie sticks with hummus, Greek yoghurt, or tomato salsa. Along with nuts and seeds or a piece of cheese.
Red meat, chicken, fish, tempeh, tofu, or lentil patties with wholegrain carbohydrates such as quinoa, pasta, noodles, or rice with plenty of vegetables or salad.
Ideally at least half of this meal should be veggies or salad.
After dinner snack
A glass of milk with Milo or Acta-Vite, a small tub of Greek yoghurt, a handful of nuts, or a piece of fruit.
When it comes to trimester three, and you’re struggling to fit a large meal in you can break your plate up into smaller quantities.
6:30 am – Eat half the quantity of breakfast oats.
8:30-9 am - Have the other half of your breakfast oats.
10:30 – One piece of fruit.
12:30 pm – Half meat and salad roll.
2:30 pm – Yoghurt.
4:30 – One piece of fruit or some nuts.
6:30 – Half dinner meal.
8:30 – 9 pm – The remaining half of your dinner.
Jessica agrees with Associate Professor Pennell and says women carrying multiples should be aware that it’s quite difficult to get all the nutrients you’ll need from food alone. That’s why it’s crucial to supplement with good quality pregnancy vitamins before, during, and after your pregnancy
Recommended Supplementation Guide
|Iron||16-20mg/d (total 27mg/d)||30mg/day|
|Vitamin D||1000 IU/day|
|Omega 3 fatty acids||300-500mg/day DHA/EPA|
“If you’re unsure what your individual nutritional requirements are, ask your doctor to recommend a dietician who specialises in nutrition in multiple pregnancies.”
You might remember my story of not realising my intense sickness was due to pregnancy, well as the weeks went by and my doctor sent me for more tests to establish what was wrong, my weight continued to drop significantly. In fact, by the time it was clear I was pregnant I weighed about 50 kilograms.
Now, by this stage, I was about 11 weeks pregnant and all I could manage to keep down were those sickly red and blue sports drinks, which isn’t ideal nutrition for trying to grow healthy babies. My obstetrician prescribed medication for the hyperemesis but after talking with my pharmacist I decided against taking it.
So, it wasn’t until I was about 17 or 18 weeks pregnant that my sickness started to subside and I could eat substantial meals again.
By the time the girls were born at 28 weeks’ gestation I had gained weight, but I only weighed 64 kilograms. Looking back, I would have benefitted from the guidance of a pregnancy nutritionist or dietician.
- Vomiting and hyperemesis are much more common in multiple pregnancies because you have two, three, or even four times the pregnancy hormones.
- In the first trimester, keep down whatever you can and focus on your water intake.
- Trimester two is when you should maximise your nutritional intake and weight gain.
- Women with multiple pregnancies should take a good quality pregnancy multivitamin, more folate than normal, and at the start of pregnancy iron and calcium in a preventable manner.
- As a rough guide, recommendations for total calorie intake per day for a woman with a multiple pregnancy would be about 3500 calories or 14,700kJ
On Season One Episode Four of Double Happiness Multiplied, we discuss Gestational Diabetes and why it’s important for women carrying more than one baby to understand how it might impact their pregnancy.
We’ll speak with Diabetes Educator, Nurse Practitioner, and Midwife Marina Mickelson about how to manage the condition, and what foods to avoid and what foods you probably need to increase in your diet.
Mum of triplets Rachelle Lear who was diagnosed with Gestational diabetes explains how she coped with the condition, and Identical twin Deb Howe who just gave birth to identical twin boys invites us along to her glucose tolerance test.
I hope you’re enjoying Season One of Double Happiness Multiplied. If you are I’d really appreciate it if you could leave a rating or review.
Until next time…
I wish you Double Happiness… Multiplied.
Double Happiness Multiplied Book
Double Happiness Multiplied – The Complete Guide to Enjoying Your Multiple Pregnancy and Building a Happy, Healthy Family Life.
Pregnancy Dietician and Nutritionist
Podcast music by:
Catherine Ashley Harpist
Australian Multiple Birth Association
Perth & Districts Multiple Birth Association
Multiples of America
Twins & Multiple Births Association
The Multiple Births Foundation
Irish Multiple Births Association
Multiple Births Canada
International Council of Multiple Birth Organisations (ICOMBO)
South African Multiple Birth Association