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Vitamin Overload In Twin Pregnancies


As I mentioned in my last post, weight gain and nutrition are commonly encountered concerns in patients with twins. Similar to the weight gain debate, there is no clear-cut answer, nor is there an absolute consensus as to the “ideal amount” micro and macronutrients a woman needs when carrying a twin gestation. Fortunately, there are studies in the works (including some here at Texas Children's Hospital) attempting to better quantify the caloric and nutritional requirements in this population. Recently, the Society of Maternal-Fetal Medicine, through a great summary paper by one of my old mentors[1], put forth recommendations for vitamin and mineral intake in twin pregnancies. With those guidelines, and valuable work by other experts in the field, we generate a customized nutrition plan for our patients based on their specific characteristics at the Program for Multiples. However, in general, the following are the recommended values I follow:
Specific Nutrient or Supplement 1st Trimester 2nd Trimester 3rd Trimester
Multivitamin with Iron (tabs) 1 2 2
*Calcium (Diet & Supplements, mg) 1500 2500 2500
**Vitamin D (international units) 1000 1000 1000
Magnesium (mg) 400 800 800
Zinc (mg) 15 30 30
DHA/EPA (mg) 500 500 500
Folic Acid (mg) 1 1 1
Vitamin C (mg) 500-1000 500-1000 500-1000
Vitamin E (international units) 400 400 400
* The calcium recommendation includes the amount taken in through diet as well as supplements. Therefore, you should check out the calcium content of your multivitamins and food intake — and ensure that you’re not exceeding the required amount, as too much calcium may lead to constipation. ** As with calcium, you should check the Vitamin D content of your daily multivitamin tablets to determine the optimal supplement amount. I would like to thank Texas Children's own Dr. Steve Abrams, an expert in this field, and Susanne Trout, our program’s dietician, for lending their knowledge and expertise on this topic. 1. Goodnight W, Newman R. Optimal Nutrition for Improved Twin Pregnancy Outcome. Obstet Gynecol 2009; 114:1121)

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Pavilion for Women