Nutrition & Weight Gain Tips to Prevent Preterm Birth in Twin Pregnancy
Twin pregnancies are exciting and special, but they also come with a higher risk of complications, including preterm birth. In fact, more than half of twins are born before 37 weeks. While some factors are beyond your control, research shows that nutrition and appropriate weight gain play a powerful role in supporting longer pregnancies and giving your babies the best possible start.
As a twin pregnancy dietitian, I help moms-to-be understand exactly what their bodies and their babies need at each stage of pregnancy. Here’s how nutrition and weight gain can make a real difference.
Why Preterm Birth is More Common in Twin Pregnancies
Carrying two babies means your body is working extra hard from the very beginning. The uterus stretches earlier, nutrient demands are higher, and the risk of complications such as preeclampsia and gestational diabetes increases. These factors can trigger early labor or the need for an early delivery.
But here’s the good news, filling your nutritional “tank” early and consistently can help reduce these risks and promote steady fetal growth, which is linked to carrying your babies longer.
The Role of Nutrition in Preventing Preterm Birth in Twin Pregnancy
1. Build Baby Growth Reserves Early
Babies born preterm often have lower birth weights, which can mean more time in the NICU. In twin pregnancies, growth in the first 20 weeks is especially important. That’s when your calorie and nutrient intake have the greatest impact on birth weight and healthier birth weights are linked to lower rates of preterm complications.
Key nutrients to focus on early:
Protein: Supports tissue growth for both babies and your expanding uterus and blood volume. Aim for high-quality sources like eggs, dairy, poultry, fish, beans and nuts.
Iron: Prevents anemia, which is linked to fatigue, preterm labor and low birth weight.
Vitamin D: Vitamin D deficiency impacts placental function and immune response which can increase the risk of preterm delivery, gestational diabetes, preeclampsia and smaller babies.
Omega-3 fatty acids: Support brain development, reduces inflammation and may reduce the risk of preterm labor.
2. Meet Increased Calorie Needs — Without Guesswork
In a twin pregnancy, your energy needs are higher than with a singleton pregnancy. You’re not “eating for three” in the literal sense, but you do need more fuel, especially from nutrient-dense foods.
The exact amount depends on your pre-pregnancy weight and health, but generally, twin moms benefit from an extra 600–900 calories per day throughout their pregnancy. These calories should come from balanced meals and snacks that include protein, complex carbs, healthy fats and fiber. By meeting calorie and weight gain goals with a nutrient dense diet, twin moms are reducing their risk of nutrient deficiencies associated with preterm birth and pregnancy complications.
3. Prevent Complications That Can Trigger Preterm Birth
Good nutrition can help lower the risk of:
Gestational diabetes — Preventing nutrient deficiency and eating a diet that supports blood sugar balance helps to support fetal growth and reduces risk of pregnancy complications.
Preeclampsia — Increasing calcium intake, meeting fiber goals and eating an anti-inflammatory diet can help reduce the risk of developing preeclampsia.
Anemia — Twin moms need more iron than women pregnant with one and have a greater risk of developing iron deficiency anemia. Anemia in pregnancy is associated with an increased risk of preterm labor and poor fetal growth. Eating an iron rich diet can reduce mom’s risk of anemia.
(Download my free Gestational Diabetes Guide for Twin Pregnancy here for more tips.)
The Link Between Weight Gain and Longer Gestation
Research from the Institute of Medicine shows that moms who reach recommended weight gain targets for twins tend to deliver later and have healthier birth weights. Some twin moms-to-be benefit from additional weight gain above the Institute of Medicine recommendations, such as IVF pregnancy, history of smoking and an underweight/normal pre-pregnancy BMI.
Recommended Weight Gain for Twin Pregnancies (IOM):
Normal BMI (18.5–24.9): 37–54 lbs
Overweight BMI (25–29.9): 31–50 lbs
Obese BMI (≥30): 25–42 lbs
What’s equally important is when you gain the weight. Front-loading weight gain in the first 20 weeks is associated with better growth and fewer preterm births. This means focusing on steady, intentional nutrition right from the start.
(Related resource: Twin Pregnancy Nutrition Checklist — grab your free copy.)
Practical Nutrition Tips for Meeting Your Twin Pregnancy Goals
Eat every 2–3 hours — frequent meals and snacks keep energy steady and help you meet calorie needs.
Pair protein with carbs at each eating occasion for stable blood sugar and sustained energy.
Include healthy fats like avocado, nut butters, olive oil, and fatty fish for brain development.
Don’t skimp on hydration — dehydration can trigger contractions.
Work with a prenatal dietitian who specializes in twin pregnancies to customize your plan.
(Related reading: What’s the Difference Between a Prenatal Dietitian and a Generalist Dietitian?)
The Bottom Line
While you can’t control every factor in a twin pregnancy, your nutrition and weight gain are powerful tools you can use to support your babies’ growth and give them more time to develop before birth. By starting early, eating intentionally and monitoring your progress, you can reduce the risk of preterm birth and set yourself up for a healthier, more confident pregnancy.
You don’t have to navigate nutrition and weight gain on your own.
Inside my Twice Nourished Nutrition Program, you’ll get step-by-step guidance, personalized meal strategies and continuous support tailored specifically for twin pregnancy. We’ll work together 1:1 to create a plan that fuels you, supports optimal baby growth and helps reduce your risk of preterm birth. Your pregnancy is unique, your nutrition should be too. Click here to learn more and start working with me today.
References:
Wierzejska RW, Aghajafari F. Review of dietary recommendations for twin pregnancy: does nutrition science keep up with the growing incidence of multiple gestations? Nutrients. 2022;14(6):1143.
Luke B, Eberlein T, Newman R. When You’re Expecting Twins, Triplets or Quads: Proven Guidelines for a Healthy Multiple Pregnancy. 4th ed. New York, NY: Harper Collins Publishers; 2017.
Lal AK, Kominiarek MA. Weight gain in twin gestations: Are the Institute of Medicine guidelines optimal for neonatal outcomes? J Perinatol. 2015;35(6):405-410.
