Before I got pregnant I knew that the whole ‘eating for two’ thing was a total myth, and that most healthy pregnant women needed no more than an extra 200 calories a day, and even then not until later in their pregnancies. It can actually be quite difficult to find sensible and reliable advice about dietary requirements during pregnancy. I’d thought that something like the Royal College of Obstetricians and Gynaecologists would be a reliable source of evidence-based information, but the only guidelines I can find on its website are clearly aimed at women who are overweight or obese before becoming pregnant. It recommends a maximum pregnancy weight gain of 1o – 12 kgs. Frustratingly, I can’t find information on the Royal College’s website that discusses any possible differences in advice for multiple pregnancy, even though logic would suggest that you might need to tailor your dietary approach if you’re nourishing two foetuses (or more).
However, I’m glad to report that my library book-requesting has already paid dividends in the form of When You’re Expecting Twins, Triplets, or Quads, by Dr Barbara Luke. Luke is an academic who has spent several decades researching maternal nutrition and multiple births, and her book summarises a lot of her findings and offers practical guidance to people like me who have a sense that they may need to take their diets seriously during pregnancy, but don’t really know what to do. What’s reassuring is that everything Luke advises is backed up with substantial research – she’s not just spinning a yarn.
So far I’ve learned that the dietary advice for multiple pregnancy is almost opposite the advice given for singleton pregnancies: instead of just eating normally and adding a few extra calories in the third trimeter, apparently I should focus on gaining healthy levels of pregnancy weight from the start. The aim of it all is to try to ensure that the babies achieve a good birthweight, and to try to prevent (or, at least, mitigate for) premature delivery (which is far more common in twins than I’d realised: it sounds like it’s fairly rare for twins to achieve their 38 week full term). Also, babies that have been well nourished in the womb are more likely to do well if they are born prematurely.
Before I became pregnant my BMI was 22, which put me right in the middle of the healthy range. According to Luke, I should aim to gain around 20 kgs throughout my pregnancy, with a lot of that weight being stacked on by 24 weeks. She really stresses the importance of early weight gain, both because of the high likelihood of not going full term (and therefore not having as much time in the third trimester to gain weight), and because it becomes increasingly difficult to eat much as a multiple pregnancy progresses and the sprogs take up more room.
Twenty flipping kilos! That’s a vast amount of weight. At my heaviest I’ve probably only been four kilos heavier than my normal weight. I’m not worried about ending up enormous – I know that it’s all for a good cause, and I’ll just have to join Weightwatchers and become a crazed boot camp person afterwards – but I can’t imagine how I’ll actually eat enough to be that much bigger. Of course, quality of food is just as important as quantity, so it’s not simply a case of eating lollies and junk food (which is just as well, given that I don’t feel like eating either). I still have very little appetite, and although I’m eating really healthily, with far more cheese and dairy products that usual, it’s a bit odd that I haven’t gained anything at all so far.
You may recall that lovely Dr Di was totally unconcerned about my lack of appetite, which puts her squarely in opposition to Dr Luke’s ‘eat eat eat’ philosophy. This isn’t the first time that we’ve experienced a well-meaning GP dishing out generic information instead of tailored advice, and it makes me so thankful that I live in an age where a) patients are empowered to be their own advocates, and b) it’s incredibly easy to access information.
Of course, I’m not going to base my diet solely on the advice given in one book: I’ll do some more research into recommended weight gain, and I’ll also bring it up at my first Shore Birth appointment tomorrow. I’ve just done some googling and have found a local nutritionist who specialises in pregnancy, so I might pay them a visit as well.