Pregnant With Twins: How Much Weight Should You Gain?

One of the questions I’m commonly asked by patients with twin pregnancies is “how much weight should I gain?” Well, to be honest, there is no clear-cut answer, nor is there an absolute consensus as to the “ideal amount” a woman carrying twins should gain. The Institute of Medicine (IOM) put forth recommendations in 2009 outlining the optimal cumulative weight gain by term in twin pregnancies. In fact, these recommendations were examined in several research projects and the results demonstrated fewer preterm births and higher birth weight in women who had a normal pre-pregnancy BMI and gained the recommended amount. With that in mind, I recommend the following amounts of weight gain over 37 weeks of pregnancy:

Pre-Pregnancy BMI	Total Recommended Weight Gain
18.5 to 24.9 kg/m² (normal weight)	37 to 54 lbs
25.0 to 29.9 kg/m² (overweight)	31 to 50 lbs
≥30.0 kg/m² (obese)	25 to 42 lbs

Due to insufficient data, the IOM did not make any recommendations for underweight women (<18.5 kg/m²). In this population, I recommend 45-50 lbs weight gain. Here at the Texas Children’s Fetal Center, as part of our Program for Multiples, our senior dietician creates a personalized nutrition plan based specifically on the pre-pregnancy BMI based needs of the patient to optimize reaching the desired weight gain goal.