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Putting Research Into Practice: What Works for Healthy Multiple Pregnancies. Barbara Luke, ScD, MPH Presented at the International Society for Twin Studies, Florence, Italy, March, 2012 . What Works for a Healthy Multiple Pregnancy. The Basics Influence of Obstetric History

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putting research into practice what works for healthy multiple pregnancies

Putting Research Into Practice: What Works for Healthy Multiple Pregnancies

Barbara Luke, ScD, MPH

Presented at the

International Society for Twin Studies,

Florence, Italy, March, 2012

what works for a healthy multiple pregnancy
What Works for a Healthy Multiple Pregnancy
  • The Basics
  • Influence of Obstetric History
  • Pre-Pregnancy Weight-for-Height
  • Pattern of Gestational Weight Gain
  • Healthy Diet
  • Selected Supplementation
  • Work and Home Factors
what works for a healthy multiple pregnancy1
What Works for a Healthy Multiple Pregnancy

The Basics

  • No smoking-including anyone in the household
  • No alcohol use
  • Reduce stress at work/home
  • Adequate rest/sleep
what works for a healthy multiple pregnancy2
What Works for a Healthy Multiple Pregnancy

Influence of Obstetric History

  • Prior, full-term, well-grown infant: adds ~two weeks
  • Prior preterm, low birthweight, or preeclampsia: increased risk in current pregnancy
what works for a healthy multiple pregnancy3
What Works for a Healthy Multiple Pregnancy

Pre-Pregnancy Weight-for- Height (Body Mass Index)

  • If underweight (BMI<20), pattern of gain is more important
  • If overweight/obese, quality of the diet is more important
what works for a healthy multiple pregnancy4
What Works for a Healthy Multiple Pregnancy

Pattern of Gestational Weight Gain

  • Weight gain goals by 20 and 28 weeks
  • Range by maternal BMI (overweight recommendations are the lower numbers, underweight are the higher numbers)

By 20 weeks By 28 weeks

  • Twins: 15-35 lbs 23-51
  • Triplets: 30-40 lbs 46-60
  • Quads/Quints: 40-50 lbs 60-70
what works for a healthy multiple pregnancy5
What Works for a Healthy Multiple Pregnancy

Healthy Diet

  • Protein & carbohydrate together at every meal and every snack
  • Eat every 3-4 hours, more often if hungry or pregnant with triplets or quads
  • Dairy bedtime snack (digested slowly)
  • Adequate hydration (urine should be pale)
what works for a healthy multiple pregnancy6
What Works for a Healthy Multiple Pregnancy

Selected Supplementation

  • Folic Acid, 4 mg/day
  • Calcium, 1-2 g/day
  • Magnesium, 400-800 mg/day
  • Zinc, 15-30 mg/day
  • Vitamin D, 25-50 mcg/day (2,000-4,000IU)
  • Omega-3 fatty acids, 1,000 mg/day or more
timing of delivery
Timing of Delivery
  • For twins: 37-39 weeks
  • For triplets: 34-36 weeks
  • For quads & quints: 32-34 weeks
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