1. 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

2. What Works for a Healthy Multiple Pregnancy 1. The Basics 2. Influence of Obstetric History 3. Pre-Pregnancy Weight-for-Height 4. Pattern of Gestational Weight Gain 5. Healthy Diet 6. Selected Supplementation 7. Work and Home Factors

3. What Works for a Healthy Multiple Pregnancy The Basics O No smoking-including anyone in the household O No alcohol use O Reduce stress at work/home O Adequate rest/sleep

4. What Works for a Healthy Multiple Pregnancy Influence of Obstetric History O Prior, full-term, well-grown infant: adds ~two weeks O Prior preterm, low birthweight, or preeclampsia: increased risk in current pregnancy

5. What Works for a Healthy Multiple Pregnancy Pre-Pregnancy Weight-for- Height (Body Mass Index) O If underweight (BMI<20), pattern of gain is more important O If overweight/obese, quality of the diet is more important

6. What Works for a Healthy Multiple Pregnancy Pattern of Gestational Weight Gain O Weight gain goals by 20 and 28 weeks O Range by maternal BMI (overweight recommendations are the lower numbers, underweight are the higher numbers) By 20 weeks By 28 weeks O Twins: 15-35 lbs23-51 O Triplets: 30-40 lbs46-60 O Quads/Quints: 40-50 lbs60-70

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

8. What Works for a Healthy Multiple Pregnancy Selected Supplementation O Folic Acid, 4 mg/day O Calcium, 1-2 g/day O Magnesium, 400-800 mg/day O Zinc, 15-30 mg/day O Vitamin D, 25-50 mcg/day (2,000-4,000IU) O Omega-3 fatty acids, 1,000 mg/day or more

9. Timing of Delivery O For twins: 37-39 weeks O For triplets: 34-36 weeks O For quads & quints: 32-34 weeks