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The Magazine for Parents of Multiples

Fostering a HEALTHY Pregnancy

Nutrition recommendations for moms carrying twins or more

amara Eberlein, of Ridgefield, Connecticut, thought she was doing everything possible to ensure a healthy pregnancy with twins. However, through no fault of her own,Tamara did not have a healthy pregnancy, and ended up delivering her boy/girl twins nine weeks premature. "When we discovered I was expecting twins, I asked my ob/gyn about additional nutrition guidelines. He told me all I needed to do was gain an extra 5 pounds," Tamara, co-author of When You're Expecting Twins, Triplets, or Quads (Harper Collins, 1999) remembers. "That wasn't nearly enough." Tamara said she wanted to write the book that she wished had been available when she was pregnant. So when Barbara Luke, Sc.D., M.P.H., R.D., offered her the opportunity to co-author a book about pregnancy with multiples, she jumped at the chance. Dr. Luke directs the University of Michigan Multiples Clinic. "I do a lot of patient education," Dr. Luke says."I teach them about their bodies, nutrition, and signs and symptoms of early labor." These visits are in addition to regular appointments with the women's ob/gyns. Over the past three years, Dr. Luke has seen a dramatic improvement in the birth weights of babies of patients.

by Betsy McLinda

When You're Expecting Twins, Triplets, or Quads is by Dr. Barbara Luke, a registered dietitian, professor of obstetrics and gynecology, and director of a pregnancy clinic for mothers of multiples at the University of Michigan, and Tamara Eberlein, an award-winning journalist and mother of twins. The book carries a positive, empowering tone throughout and includes information about assembling a team of health care providers, specific diet guidelines for maximizing birth weight, rest guidelines, symptoms of preterm labor and post-pregnancy feeding and care tips. It is available for $14.00 through the TWINS Bookshelf.

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"On average, we can improve birth weight 18% to 20% for twins and 35% for triplets," says Dr. Luke, who sees between 45 and 50 patients a year. "In our program, 70% of our twin moms deliver after 36 weeks, compared to 40% of mothers who don't come to this clinic." Helen Armer of Ann Arbor, Michigan, was a patient of Dr. Luke's when she was pregnant with triplets. At birth, her triplets were 4 pounds, 11 ounces; 4 pounds, 12 ounces; and 5 pounds, 13 ounces. "All multiple births are high risk," Helen says. "You should seek out a specialist as soon as you know you have a multiple birth pregnancy."

Early efforts pay off

The pattern of weight gain during pregnancy is more important than the total amount of weight gain. The average-sized woman pregnant with multiples should gain: Twins--24 pounds by 24 weeks; 40­50 pounds total Triplets--36 pounds by 24 weeks; 50­60 pounds total Quadruplets--50 pounds by 24 weeks; 65­80 pounds total "We don't think of the special nutritional demands for a multiple pregnancy as a burden. Instead, we see them as a means of empowerment," Dr. Luke says. Stacy Moore of Plymouth, Michigan, went through the program in 1997. She says, "The program gave me an element of control over my pregnancy and increased my confidence to carry my twins to term." Her twins, Steven and Brandon, were born at 38 weeks weighing 6 pounds, 11 ounces and 6 pounds, 1 ounce respectively. Dr. Luke divides pregnancy into three time periods that differ from trimesters.

Twins Kayla and Micah

Weight gain before 20 weeks dramatically affects fetal growth in the middle and late periods. Weight gain during 20 to 28 weeks immediately affects the growth of the fetuses, whereas weight gain from 28 to 36 weeks does not affect the weight of the fetuses as much as the first and second periods.

Triplets Madeleine, Jonathan and Matthew

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"Your prepregnancy weight is a vital consideration as well," Dr. Luke says."If you are underweight when you conceive, you should aim to gain the additional amount of weight it would take to bring you to the normal body weight for your height and build. If you are overweight at conception time, you still must gain a reasonable amount of weight from eating the right foods. This is usually about 10 pounds less than our normal recommendations." "I was underweight when I became pregnant with twins," says another Ann Arbor native, Judy Levy, mother of fraternal girls who were 6 pounds, 4 ounces and 7 pounds at birth. "Dr. Luke wanted me to gain 40 pounds by 24 weeks, and I did it with her help. She gave me concrete examples of foods to cure my nausea so I could eat what was recommended in the program." A "salty-and-sweet" approach is among the newest treatments for morning sick-

ness. Judy would eat some potato chips and a glass of lemonade when she felt nauseous. Soon she would feel well enough to eat foods prescribed in the program's diet.

Food power is important

Dr. Luke's nutritional guidelines recommend that 40% of a woman's daily diet come from carbohydrates (breads, cereals, pasta, dairy and fruit), 40% from fat (dairy, nuts and oils), and 20% from protein (meat, seafood, poultry and dairy). "It's a very balanced diet," Dr. Luke says. "But, my emphasis is on animal protein from meat. It takes protein to build protein." The recommended number of daily calories is 3,500 for women carrying twins, 4,000 for triplets and 4,500 for quad mothers. This may seem impossible at first, but can easily be divided into three main meals and four hearty snacks.

Finding help

Women pregnant with multiples may want to seek the care of a registered dietitian. Most insurance carriers will pay for this when the patient is referred by her ob/gyn. To find a nutrition specialist, visit the American Dietetic Association's web site at www.eatright.org or call (800) 366-1655.

Twins Steven and Brandon with father, Tim

Quads Mason, Andrew, Lindsey and Sarah

Menu Guidelines for Mothers of Multiples

Nonpregnant Singleton

Pregnancy Nursing

Twins

Pregnancy Nursing

Triplets

Pregnancy Nursing

Quadruplets

Pregnancy Nursing

Calories (kcal.) Protein (grams) 20% of calories Carbohydrates (grams) 40% of calories Fat (grams) 40% of calories

2,200 110 220 98

2,500 126 248 112

2,700 135 270 120

3,500 176 350 155

3,200 160 320 142

4,000 200 400 178

3,700 185 370 164

4,500 225 450 200

4,200 210 420 187

Examples of good snacks are a bowl of cereal with whole milk and a piece of fruit, or a whole tuna fish sandwich. Serving sizes are also important. For example, a mother expecting quads is advised to eat 12 1-ounce servings of animal protein a day. This does not mean 12 steaks. It could mean 12 ounces of steak or an 8-ounce steak and a 4-egg omelet. Pregnant women can also get a big boost with nutritional shakes and supplements. Another important part of the diet is water intake. Women pregnant with multiples are advised to drink at least eight 16ounce glasses of water each day. A good way to monitor your water intake is to fill four 32-ounce jugs of water each night for the following day. Drinking enough water could help prevent preterm labor since dehydration is often a factor in early labor. "Anytime I slacked off on my water intake, I got dehydrated and started having contractions--sometimes as many as 12 an hour," says Anne Seifert of Jerome, Michigan, mother of healthy quadruplets.

Promoting positive pregnancy outcomes

Serving Sizes Dairy 8 oz. (1 cup) milk;

Servings Per Day 4 6 8 8 10 10 12 12 14

8 oz. (1cup) calcium fortified cottage cheese; 8 oz. (1cup) ice cream; 1 oz. (1slice) hard cheese Meat, fish, poultry 1oz. Eggs 1 fresh Vegetables 1/2 cup cooked or 1 cup fresh Fruits 1/2 cup or 1 fresh piece Breads and grains 1oz.; 3/4 cup cooked; 1 slice Fats, oils and nuts 1 Tbsp. oil; 1 pat butter; 1 oz. nuts 6 ­ 4 4 8 6 1 4 4 8 6 1 4 4 8 10 2 4 7 10 6 2 4 5 10 10 2 5 8 12 7 2 5 5 12 12 2 6 8 12 9 3 6 5 12

Dr. Luke sets a multiple's target birth weight at about the 50th percentile of the singleton birth weight, which is about 6 pounds, 3 ounces for the 36th week of gestation."If the birth weight of your children is as close to their genetic potential as possible, it has a huge ripple effect toward starting their childhood as healthy individuals," she says. Tamara agrees. "You can make a difference in the outcome of your pregnancy," she says. "It's not your fault if something goes wrong, but there's a lot you can do to stack the odds in your favor."

Betsy McLinda of Wheat Ridge, Colorado, is a former assistant editor of TWINS Magazine. She is an identical twin.

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SOURCE: WHEN YOU'RE EXPECTING TWINS, TRIPLETS, OR QUADS (HARPER COLLINS, 1999)

© Copyright 2004 by The Business Word Inc. It is illegal under federal copyright law to reproduce, fax or input electronically this publication or any portion of it without the publisher's permission.

To Raise Twins the Right Way, You Need the Right Information

Raising multiples is one of the most physically and emotionally demanding times you will ever experience. Moms and dads call it "twinshock." That's where TWINS Magazine can help you. TWINS is bursting with practical and fun ideas and information to make your life easier. The information-filled articles in TWINS are written by experts -- professional psychologists, physicians and counselors, many of whom are parents of multiples. And you'll love the wonderful stories by other parents that convey an important message -- you're not alone!

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The Psychology of Twins

A practical handbook for parents of multiples

Herbert L. Collier, Ph.D. Twins do differ from singletons and, just as importantly, from each other. Herbert L. Collier, a psychologist and father of twins, draws on firsthand experience and from counseling families with multiples. For the parent who wants to understand and value each child as an individual. Published by TWINS Magazine $13.95

Twins to Quints

The Complete Manual for Parents of Multiple Birth Children

Edited by Rebecca E. Moskwinski, M.D. Compiled by the National Organization of Mothers of Twins Clubs and edited by the club's Education Vice President Rebecca E. Moskwinski, M.D., this book is packed with medical research expert advice and hundreds of practical "been there, done that" tips from NOMOTC members.

$18.00

The Twinship Sourcebook

Your guide to understanding multiples

From the editors of TWINS Magazine The leading source of information for parents of multiples. This handy, one-of-akind guidebook helps you understand and cope as your multiples grow from birth through the school years and into adulthood. Topics include temperament and personality, twintypes, and whether to separate or not in school. If you have only one book on multiples, this is the one to have! An ideal gift to suggest to your friends and family! Published by TWINS Magazine $14.95

TWINS!

Pregnancy, birth and the first year of life

Connie Agnew, M.D., and Alan Klein, M.D., with Jill Alison Ganon Two physicians aim to provide information on the physical, medical, emotional and psychological issues involved in having twins. Covers the pregnancy, birth and postpartum experiences with an emphasis on twin-specific issues and the crucial first year with a month-to-month guide, and also addresses understanding and coping with twins' differences. $18.00

To order a subscription or books, call 1-888-55-TWINS or use order form on back

Magazine Special Reports

Each special report is an updated compilation of the best articles from TWINS Magazine on topics of concern. Feeding Multiple Babies The simple questions--such as whether to breastfeed or bottle feed, weaning, handling colic, and many more--become more complicated when there are two or more baby appetites to deal with. Full of useful insights from mothers who have been there! 40 pages. Tips and Tools for New Parents of Twins and Triplets When "twinshock" hits new parents, it hits hard. This compilation of special articles will be a blessing to new parents of multiples when their babies are young, providing practical, encouraging advice about coping with day-to-day challenges. 52 pages.

NICU This collection of articles is designed to help parents more easily deal with their fears of the neonatal intensive care unit of hospitals, the challenges of nurturing premature babies, and bringing home their tiny babies. 54 pages. Health & Safety for Infant Multiples From choosing a pediatrician to ear infections and diaper rash, all parents of multiples will benefit from the simple, essential advice about the health of their babies. 40 pages. Premature Twins and Triplets This wonderful collection of articles helps frightened parents deal with the big and little traumas they must face as their small, prematurely born multiples enter life with extra health problems. 44 pages. $8.95 for one or $14.95 for two ($5.50 for each additional)

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