When pregnant with twins, trying to get a balanced diet with enough protein, carbohydrates, calcium and energy is important for your health and your babies’ health.

Protein

Protein helps with babies’ growth and also supports your needs when pregnant. A woman pregnant with twins needs an extra 50 grams of protein each day compared to someone pregnant with one baby. What does that look like? Those extra 50 grams would be equal to 220 grams (8 ounces) of meat or eight large eggs or about two and a half cups of cooked lentils. Keep in mind that this is on top of the usual amount needed for a pregnancy with one baby. A 60 kg (132 pound) woman would need about 66 grams per day if she’s carrying one baby or 116 grams per day for a twin pregnancy. 

Carbohydrates

Your carbohydrate needs are also higher with a twin pregnancy. You should aim for a minimum of 208 grams of carbohydrates daily to help with your babies’ development, your weight gain and to prevent ketones (a chemical you make when you don’t get enough carbohydrates). This is equal to six-and-a-half slices of whole wheat bread or four cups of rice or five cups of cooked pasta or seven-and-a-half chapatis.

Calcium

Getting enough calcium is important to help with growth, as well as maintenance of bones and teeth for you and your babies. It’s also important for helping to control blood pressure during pregnancy. All pregnant women should include three to four servings of calcium daily to meet your needs. Mix and match the calcium-rich foods you enjoy to ensure you receive enough. Each of the following is considered one serving of calcium:

• One cup of milk or fortified milk alternative (e.g. soy beverage, rice beverage, almond beverage)
• 1/3 cup of cubed pasteurized cheese
• One cup of yogurt

I’m feeling really nauseous – what are some tips for eating well?

It can be challenging to eat enough food if you are feeling nauseated or if your babies are not leaving you a lot of room in your stomach to eat. Here’s my advice to help you get enough to eat:

1. Have small, frequent meals and snacks with both carbohydrates and protein, for example:
   • Fruit and cheese
   • Greek yogurt and cereal
   • Hummus and pita
   • Sandwich with a cup of milk
   • Crackers with peanut butter
2. Include protein with every meal. Protein is found in:
   • Eggs
   • Fish – choose low mercury options like salmon, rainbow trout or sardines
   • Poultry (chicken, turkey)
   • Meat
   • Legumes/pulses (beans, lentils, chickpeas)
   • Greek yogurt
   • Cheese, cottage cheese
   • Tofu
   • Textured vegetable protein (e.g., veggie burgers, veggie dogs)
   • Nuts, nut butters (e.g. peanut butter)

We also recommend you take a prenatal vitamin each day. Discuss any other supplements with your health care provider.

What about my weight gain?

Recommended weight gain in twin pregnancies is based on your pre-pregnancy body mass index (BMI). You can calculate your pre-pregnancy BMI here.

If your pre-pregnancy BMI was between 18.5-24.9 it is recommended that you gain between 17-25 kg, or 37-54 pounds, throughout your pregnancy. If it was 25-29.9, the recommended weight gain is 14-23 kg, or 31-50 pounds. If your pre-pregnancy BMI was 30 or more weight gain of 11-19 kg, or 25-42 pounds, is recommended.

As most people with twins deliver before 40 weeks gestation, weight gain earlier in pregnancy is recommended. If you are finding it difficult to gain weight or get enough to eat, ask your care provider for a referral to a registered dietitian. 

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The World Health Organization (WHO) recommends we aim to keep our sugar consumption to below 6 teaspoons (25 g) a day for health benefits. “This refers to monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates,” according to WHO.

There’s a few obvious ways we can reduce our sugar intake (cut out sugary things, like pop, for example).

But, sometimes it’s a little more sneaky. Here’s a list of 5 of the top offenders in the hidden sugar department. My patients (and family and friends) are often shocked that these are on the list.

Juice:

Watch out! Even freshly squeezed juice contains sugar. These naturally occurring sugars from fruit juice or fruit juice concentrate still count towards your daily sugar intake! Be smart. Switch to water. If you need some flavour, try cutting up a lemon or other fruit to infuse the water that way.

Flavoured yogurt:

That low fat yogurt that still tastes delicious – be careful! It might have loads of sugar. A spot-check of my colleague’s 100 g yogurt this morning revealed it had 12 g of sugar. Food labels don’t distinguish between added sugars and naturally occurring sugars.

Yogurt has other health benefits, but just limit your intake and try to choose low sugar options.

Cereal:

Yes, we know that the “sugary cereal” brands should be avoided – but watch out for health-branded cereals too. Granolas often contain lots of sugar (think upwards of 30 grams per 100 gram serving).

“Healthy” sweeteners:

There seems to be a move toward “healthy” sweeteners like honey, agave and maple syrup. These taste delicious. But they are still sugar.

Ketchup:

Yup, this kid favourite is packed with sugar. So, limit Junior’s ketchup intake or make your own at home!

How’s your sugar intake? Are you doing anything to cut down?

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1. Quit smoking.

If you smoke, make a plan to quit. (And if you don’t smoke, don’t start. Within months, quitting smoking reduces your risk of a heart attack, improves breathing and helps circulation. After a year of quitting, your risk of heart disease and smoking-related heart attack is cut in half. Start by making a quit plan. Need help? Check out sunnybrook.ca/quitsmoking or talk to your health-care provider.

2. Cut down on sugar.

The World Health Organization (WHO) suggests we try to keep our sugar intake to less than 6 teaspoons a day (not including naturally occurring sugars, like in fruits). Eating too much sugar has been linked to cardiovascular disease and other health issues. Do you put two sugars in your tea? Try cutting back to one. (Even better, none!) Keep an eye out for hidden sugars. Cereals, yogurts, salad dressings and sauces can often have a wild amount of added sugar. Choose these items with less sugar (or use less dressing when tossing your greens!)

3. Add an extra veggie to each lunch.

Cut up some celery sticks to eat with your sandwich, or add broccoli to your pizza. Sneaking an extra vegetable in at lunchtime can help you reach Canada’s Food Guide recommended servings of vegetables/fruits (7-8 for adult women, 8-10 for men). Eating the recommended amount of vegetables can help reduce your risk of many chronic diseases.

4. Try a meatless Monday (or at least one meatless meal per week)

Have one vegetarian meal each week that includes legumes like beans, chickpeas or lentils. Legumes are packed with protein and fibre, and are lower in saturated fats than most meats. Eating more legumes can help manage diabetes and improve cholesterol levels. Need inspiration? Try this three-bean chili. 

5. Add three 10-minute chunks of activity to each day.

We know you’ve heard this one: adding daily activity to your lifestyle has many health benefits. But remember, daily activity doesn’t mean you have to spend hours at the gym. Try to add three 10-minute chunks of medium activity. Park farther away from the doors and briskly walk, get off the bus a stop early, have a walking meeting or take the stairs). Check out Canada’s Physical Activity Guidelines for more ideas.

 6. Take electronics out of the bedroom.

To improve your sleep quality, make your bedroom a no-phone zone. Leave phones, TVs, tablets or other things with bright screens out in the living room. Actually, studies show that avoiding these devices one hour before bedtime can improve your sleep quality, leaving you better able to make healthy choices the next day.

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Here are some tips to help you make healthy choices when your schedule is busy (and the smell of fries is filling the halls).

Your best option is to eat at home before you go and avoid the food court all together. But if you have a full day planned at the mall, try these tips for eating at the food court:

• Walk around and scope out your options before you buy: Be sure to do a quick tour of the food choices. Is there a healthier choice down the hall?
• Choose wisely: Avoid the deep fried foods and be sure to include vegetables on your plate, like salads or veggie toppings on your sandwich/pizza.
• Size matters: Yes, we are invited to supersize lunch. But don’t give in to the marketing! Opt for smaller portions sizes and share with your shopping buddies.
• Say no to soda (and fancy coffees): Choose water, diet pop or coffee or tea with 1 per cent milk instead of regular pop or fancy coffee drinks.
• Take advantage of the take-out containers: Don’t feel the need to eat it all at once – save some for your lunch tomorrow!
• Pack a portable snack: Put a fruit, granola bar or cheese string in your purse or pocket so that you can reenergize quickly (and only make one trip to the food court).
• And to finish? If you really need dessert, choose a fruit-flavoured frozen yogurt or sorbet and avoid the huge bag of sugary or salty popcorn, ice cream or chocolate shops.

It is possible to make healthy choices when out and about. What snacks pack a punch for you?

Stopping for a sit-down lunch or dinner? Follow our tips for Dining Out.

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