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How to Eat Right for Your Multiple Pregnancy

Morning sickness! It’s the very thing that wipes the glow from a pregnant woman in an instant. And, when you’re expecting more than one baby it can be incredibly draining, especially when it lasts all-day-long.

So, when your second most used room has become the toilet, how do you get adequate nutrients on board to grow healthy babies and ensure your body is up to the task of breastfeeding? And, even if you’re one of the lucky ones who isn’t on round the clock bathroom visits, what’s the best eating plan to get you and your babies through pregnancy?

But, first things, first.


It’ll be no surprise, that 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 will 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.

Chair in Obstetrics and Gynaecology and Professor Fetal Medicine, Head of Discipline Obstetrics and Gynaecology at the University of Newcastle and John Hunter Hospital Professor Craig Pennell tells us 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, and because she’s making an extra litre-and-a-half to two-litres of maternal blood, plus two placentas, plus two baby blood volumes, she will use up extra iron.

Associate Professor Pennell advises women with multiple pregnancies to take a good pregnancy multivitamin, more folate than normal, and iron and calcium in a preventable manner right at the start 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.”

~Professor Craig Pennell~”

“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.


Now, as mentioned earlier morning sickness is a huge inconvenience during pregnancy, however, when that constant queasiness shifts gears and becomes the more serious form known as hyperemesis, where vomiting takes over your existence, it becomes much more difficult to function as you’d like. Unfortunately, this exacerbated form of morning sickness is much more common in multiple pregnancies simply 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.”

~ Professor Craig Pennell~

Professor 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.

“I was fairly well bedridden for a large chunk of my pregnancy.”

~Elyse Jamieson~

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. As someone who prides herself on eating the rainbow of organic foods, she admits there were weeks where she just couldn’t stomach anything. Once she was able to eat again, she resumed her usual diet while listening to her body and ate to her hunger.

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 managed to maintain consistent weight gain.

Mum of quadruplets Jannelle Snaddon says despite being pregnant with quadruplets she didn’t struggle with eating as much as she expected.

At the start of her pregnancy, she ate a lot of really heavy foods – lots of carbohydrates and protein. Jannelle believes this could be the reason she didn’t get the intense sickness that most other mums of multiples do early on in their pregnancy.

“When I went inpatient at 26-weeks’ gestation the nurses started making me protein drinks to get enough nutrition in,” 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.”

~Jannelle Snaddon~

When there’s no room for food

According to Associate 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 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.

Where is the weight being gained?

By the end of your pregnancy with twins you’re looking at:

  • Two extra litres of blood – 2kgs

  •  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,” 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.”

~Professor Craig Pennell~

The Consequences of Inadequate Weight Gain in Multiple Pregnancies

Associate 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 Professor Pennell.

Nutrition and Weight Gain in your Multiple Pregnancy

It might come as a surprise to you, however, there are no specific dietary guidelines for multiple pregnancies, there certainly are for women carrying singletons, though. Pregnancy Dietician and Nutritionist Jessica Ruescher from Essence of Eating says despite this she has developed guidelines to assist. She explains that the calories/energy needed each day depends on your pre-pregnancy weight, genetic makeup, and cultural background.

Jessica has worked out, as a rough guide, the 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 breads 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.

Morning Tea

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.

Afternoon Tea

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.

Third Trimester

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.

For example:
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.

Recommended Supplementation Guide

Jessica agrees with Professor Pennell and says women carrying multiples should be aware that it’s quite difficult to get all the nutrients you’ll need to grow your babies from food alone. That’s why it’s crucial to supplement with good quality pregnancy vitamins before, during, and after your pregnancy.


“If you’re unsure what your individual nutritional requirements are, ask your doctor to recommend a dietician who specialises in nutrition in multiple pregnancies.”

~Jessica Ruescher~

FREE Nutrition during your multiple pregnancy download

Sally’s Story

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 twins. 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, such as Jessica.

Until next time…

I wish you Double Happiness … Multiplied.


Key Points

  • 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
    would be about 3500 calories or 14,700kJ
Disclaimer: The content contained within this article is purely informative and educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriately certified medical or healthcare professional.


Nutrition Guide for Women Carrying Multiples

Double Happiness Multiplied – The Complete Guide to Enjoying Your Multiple Pregnancy and Building a Happy, Healthy Family Life.

S1 E3 – Nutrition & Your Multiple Pregnancy

Jessica Ruescher

Pregnancy Dietician and Nutritionist

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

About the author, Sally

Sally Barker is a Hypnotherapist, Meditation Mentor, Pregnancy & Birth Trauma Coach, Podcaster, Author, and Educator on the topic of Multiple Births.

First and foremost, though, she is the proud Mamma of identical twin girls.

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