--- title: 'Twins or Multiples: What Changes About Nutrition in Pregnancy' slug: nutrition-multiple-pregnancy-twins-what-to-eat lifeStage: pregnancy category: Nutrition medicalReviewer: 'Sophie Mumby, Registered Dietitian' reviewerId: 'https://blog.bloume.com/pregnancy/medical-board.md#sophie-mumby' lastUpdated: '2026-08-14' primarySource: 'Nutritional Goals During a Twin Pregnancy' wordCount: 1277 readTimeInSeconds: 319.25 --- # Twins or Multiples: What Changes About Nutrition in Pregnancy Carrying more than one baby changes what your body needs from food. The tiredness can feel heavier, your appetite compresses sooner, and your body is working harder than before. This article covers the key shifts in nutrition for a multiple pregnancy: higher energy and protein needs, greater iron and folate demands, and practical ways to eat well when your stomach has less room. Because needs vary so much from person to person, talk with your midwife, obstetrician, or a registered dietitian before acting on any specific targets here. **Q: Do I need more calories when carrying twins than in a singleton pregnancy?** A: There are no official UK guidelines on this. For some, the guidelines remain that an additional 200kcal in the third trimester should be enough. It's worth discussing your individual targets with your midwife, obstetrician or registered dietitian. When you are carrying twins, the heaviness can set in earlier, fullness arrives after just a few bites, and your body still needs more from every meal. Eating for a multiple pregnancy is not simply a bigger version of singleton advice. The demands on your body change, and getting to grips with those differences gives you a practical place to start. Your midwife or obstetrician can give you targets that fit you. This article covers the key areas so you can walk into those conversations already prepared. > **WARNING**: Your nutritional needs in a multiple pregnancy are very individual. They depend on things like your weight before pregnancy, your health history, and how many babies you are carrying. Talk through any supplements and specific dietary targets with your midwife, obstetrician, or a registered dietitian before you act on them. ## How energy needs differ in a twin pregnancy In the UK, there isn't specific guidelines around nutritional needs in a twin pregnancy. However many experts agree that it is likely that nutritional needs will increase with each baby carried. The current guidance remains at an extra 200kcal in the third trimester only, the same as a singleton pregnancy, but your individual circumstances are best discussed with your healthcare team. ## Increased protein requirements for twins Protein helps all babies grow and develop correctly throughout pregnancy. Your protein requirements also increase as you grow the placenta, your expanding uterus and other maternal tissues required to support pregnancy. In the UK there is again, no specific guidance on protein requirements in twin or multiple pregnancies. If you are concerned about your protein intake discuss this with your healthcare team. Easy sources of protein include lean meat, eggs, beans, nuts, and fish. If you eat a plant-based diet, beans, lentils, tofu, nuts, and seeds can do a lot of the work. If you eat fish, there is standard pregnancy guidance to follow on safe amounts, which sets limits on oily fish and advises steering clear of shark, swordfish, and marlin. If you are thinking about high-protein shakes to top up your intake, check the product with your healthcare team first, since they vary and not all are suitable in pregnancy. ## Iron needs and anaemia risk in multiple pregnancy Anaemia, which means your iron has run low, is more likely to occur if you are carrying twins or multiples compared to a singleton pregnancy. Each baby draws on your iron stores, so with more than one on board your levels can dip more easily, and that often shows up as tiredness. Your antenatal team will keep an eye on your iron levels and you should be offered an additional blood test at 20 to 24 weeks. In the UK the recommended dietary intake of iron is no difference in singleton or multiple pregnancies and remains at 14.8mg per day. Instead, you will be offered additional screening and prescribed iron supplementation if required. Good dietary sources of iron include red meat, poultry, beans, lentils, pulses, green leafy vegetables, dried fruit and fortified breakfast cereals. Although liver is an excellent source of iron it is best avoided in pregnancy due to its high levels of vitamin A. Tannins found in tea and coffee can inhibit iron absorption, so these are best avoided around mealtimes, whereas vitamin C can aid absorption so try having some tomato or oranges with foods which are high in iron. ## Folic acid: why the standard supplement may not be enough The UK guidance for folic acid in twin pregnancies remains that same as in singleton pregnancies, which is a 400mcg supplement for the first 12 weeks unless you have a specific health reason (e.g. diabetes or coeliac disease) requiring 5mg. This is likely because the neural tubes are likely fully closed before most women will know they are carrying multiples. Some NHS trusts suggest a 5mg supplement throughout your entire pregnancy, check with your midwife or GP about what is best in your individual circumstances. > **WARNING**: In the UK, 5 mg folic acid is a prescription-only medicine. You cannot buy it over the counter at the usual supplement shops. Speak to your GP or midwife before starting any higher-dose supplement, and do not try to source or take it without a prescription. ## Practical eating when your appetite is suppressed As your babies grow, they put more pressure on your stomach reducing your capacity to eat large volumes of food. For some big portions feel daunting and impossible, as the babies continue to grow they take up more and more room, leaving less space for your stomach. Trying to eat little and often can be much more manageable, try to have smaller portions of your main meals but have additional snacks throughout the day. ### Getting more energy from smaller portions Adding calorie-dense extras to your usual meals is one way to get more in without eating larger portions. You might stir cream into porridge, scatter nuts and seeds over your food, or add hummus or mayonnaise to a sandwich. If you use mayonnaise, choose one made with pasteurised eggs. Homemade or restaurant mayonnaise made with raw eggs carries a food safety risk in pregnancy, so it is best avoided. ### Making fluids work harder Making sure you stay hydrated can also be challenging. Drinking lots with a meal can fill you up leaving less room for food. Try to constantly sip drinks throughout the day to ensure you remain hydrated. If you are struggling to eat enough, nourishing drinks such as milkshakes, smoothies, fruit juices or just a glass of milk (or plant-based alternatives) can be an excellent way to get additional calories and nutrients into your day. --- If you are finding it hard to eat enough, or you have questions about your weight gain, iron levels, or supplement plan, bring it up at your next antenatal appointment. Your midwife can refer you to a registered dietitian who specialises in pregnancy if your needs are more complex. **Q: Do I need more calories when carrying twins than in a singleton pregnancy?** There are no official UK guidelines on this. For some, the guidelines remain that an additional 200kcal in the third trimester should be enough. It's worth discussing your individual targets with your midwife, obstetrician or registered dietitian. **Q: Is a standard folic acid supplement sufficient in a twin pregnancy?** There are no specific UK guidelines on folic acid in twin or multiple pregnancies. For most the guidelines remain at 400mg until 12 weeks. Some NHS trusts recommend 5mg throughout your entire pregnancy, whereas some health condition require you to have 5mg for the first 12 weeks. It's best to speak with your healthcare team to get individual advice for your specific circumstances. **Q: How can I eat enough when my appetite feels small?** Small, frequent, high-energy meals with two or three snacks a day tend to feel more manageable than three large meals. Boosting the calorie density of your food, with nuts, seeds, cream, or hummus, helps you get more from smaller portions. Drinking nourishing fluids like milk or smoothies between meals rather than with them can also keep stomach space free for food. Your midwife or a registered dietitian can help you put a practical plan together. **Q: Why is iron particularly important in a multiple pregnancy?** Each baby draws on your iron stores through pregnancy, and carrying more than one raises your chances of anaemia, where your iron runs low. Your antenatal team will check your iron levels routinely. If you need a supplement, your GP or midwife will advise the right dose for you, since the amount varies from person to person and is not something to self-prescribe. ### Clinical Sources - [Nutritional Goals During a Twin Pregnancy](https://www.brighamandwomens.org/campaigns/mfm-nicu/nutritional-goals-during-a-twin-pregnancy) - [Antenatal care for women with a multiple pregnancy](https://www.southtees.nhs.uk/resources/antenatal-care-for-women-with-a-multiple-pregnancy/) - [Twin Pregnancy: Obstetric Care Guidelines](https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/for-medical-professionals/twin-pregnancy-obstetric-care-guidelines) - [Twin Pregnancy: Obstetric Care Guidelines](https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/for-medical-professionals/twin-pregnancy-obstetric-care-guidelines) - [Diet Sheet For Women Pregnant with Multiples](https://rotunda.ie/rotunda-pdfs/PIL/Nutrition/Multiples%20Diet%20Sheet.pdf?_t=1779794634) - [Nutritional Goals During a Twin Pregnancy](https://www.brighamandwomens.org/campaigns/mfm-nicu/nutritional-goals-during-a-twin-pregnancy) - [Diet Sheet For Women Pregnant with Multiples](https://rotunda.ie/rotunda-pdfs/PIL/Nutrition/Multiples%20Diet%20Sheet.pdf?_t=1779794634) - [Diet Sheet For Women Pregnant with Multiples](https://rotunda.ie/rotunda-pdfs/PIL/Nutrition/Multiples%20Diet%20Sheet.pdf?_t=1779794634) --- Reviewed by Sophie Mumby, Registered Dietitian | [Medical Board](https://blog.bloume.com/pregnancy/medical-board.md) | August 2026