Triplet pregnancy

Multiple pregnancies such as twins and triplets occur in 3 out of every 100 pregnancies in Australia at present. Over the last 20 years there has been an increase in number of triplet pregnancies, with a major contributing factor being the increasing use of assisted reproductive technologies such as IVF.

Triplet pregnancies are also considered one of the highest risk conditions faced in pregnancy, with infants more likely to suffer from problems such as intrauterine growth retardation and low birthweight that can severe implications on your babies’ health. A poor maternal diet lacking in nutrients is said to be a contributor to this.

The page Twin Pregnancy discussed important principles relating to diet in multiple pregnancies, and should be read in conjunction with this.

What happens to my body in triplet pregnancy?

When having triplets or higher multiples, the extra bodies that grow inside your uterus magnify the nutritional requirements throughout your pregnancy. Overall there is a much greater drain on your own resources as well as accelerated depletion of nutrient stores, meaning that it is extremely important that you are consuming the right type and amount of foods in your diet.

  • Triplet pregnancies are known to have a shorter gestational period or length of pregnancy, meaning that you will have your babies’ earlier than the expected due date. Hence there is a shorter amount of time for your babies’ to achieve optimal growth. Your diet must become a priority to help ensure your babies’ get all their nutritious needs and any deficiencies are addressed in a timely fashion.
  • Having triplets is characterized by early weight gain, especially a significant amount prior to 20 weeks gestation. This is due to the quick response of your body to acquire maternal nutrition stores, deposition of body fat and hormonal effects that occur with carrying at least 3 babies.
  • Most of your weight should be gained prior to 28 weeks into your pregnancy as this is shown to have the greatest influence maximizing on your babies’ birth weights. Refer to Twin Pregnancy for weight gain guidelines.
  • You are at higher risk of nutrient deficiencies due to increased requirements associated with carrying and sustaining three babies within your uterus. The most common deficiencies seen include iron, folate, calcium, zinc and Vitamin D.
  • Morning sickness and the more serious form of vomiting, hyperemesis gravidarum, tend to be more common in triplet pregnancies due to higher amounts of hormones. The symptoms can be quite severe and make your diet extremely poor and nutrient deficient, as well as suffer from weight gain. Read the page Nausea and Vomiting for more details.

What should my diet comprise of?

There is no specific diet available for you to follow when expecting triplets, similar to twin pregnancy as discussed previously. However a dietitian referral and consideration of the following basic principles should help get your diet on track for having healthy growing babies:

Your diet during a triplet pregnancy should include:

  • An extra 3500 calories per day versus your non-pregnant diet. This will however depend on your pre-pregnancy weight.
  • 3 main meals with 3 small snacks during the day
  • Meals should comprise of 40% carbohydrate, 40% fat and 20% protein mix, and be of low glycaemic index
  • This will help stabilize blood sugar levels within your body and provide your growing babies with a continual supply of energy.

Nutrient demand will increase in triplet pregnancy versus if you were carrying just a single fetus. Often supplements are encouraged as a nutritious diet supplying all this goodness can be difficult to sustain and supplements will ensure deficiencies are avoided.

  • Multivitamin supplement – This is to ensure that you are receiving all of the desired nutrients. Having twins however doesn’t mean that you just ‘double’ your multivitamin tablets, as too much will provide your body with toxic levels of Vitamin A, which can be harmful to the babies. It is advised that you just take the standard dose – 1 multivitamin tablet per day.
  • Iron – This is due to the increased volume of blood in your body and demand for red cells is far greater. Iron levels tend to drop naturally in pregnancy, however when expecting triplets these will drop even further. You are 2-4 times more likely to develop iron deficiency anaemia than if you were carrying 1 baby. It is therefore recommended that you take Iron supplements to avoid an anaemic state, starting off with 1 Iron tablet per day (30mg). This may increase to 2 at some stage depending on your blood results.
  • Folic Acid = Folic acid is important to avoid neural tube defects as discussed in the Folic Acid chapter. It is advised that once your doctor has confirmed that you are carrying triplets; you increase your folic acid intake to 1000mcg per day.
  • Calcium = Calcium is needed to help build and maintain the strength of your babies’ developing skeletons, as discussed the Calcium chapter. As well as consuming 2-3 serves of calcium- rich dairy foods a day, it is recommended that you take an additional calcium supplement from second trimester onwards.
  • Vitamin D = Vitamin D is also an important nutrient in helping strengthen your babies’ bones. The requirements for Vitamin D are the same as a single pregnancy, however you are more likely to be deficient with increased usage of nutrient to sustain three babies. It is recommended that you start taking supplements, consisting of 1 tablet or 1000 units of Vitamin D a day, however this may increase depending on your levels.

What is the Brewer Diet?

A well-known diet for women expecting twins or more babies is the “Brewer Twin Pregnancy diet.” This diet has been devised by an American doctor and website address for this can be found on the Links page. No randomized trial has been conducted on this diet however it does follow safe principles, but like any diet should be discussed with your doctor prior to commencing. This diet is based on the following principles:

  • Based on providing a steady state of food to the baby, by consuming regular meals and not going for more than 12 hours without good food
  • Daily diet structure consists of 3 main meals and 3 small snacks during the morning, afternoon and prior to sleeping snack
  • Consists of the Brewer Basic Diet plus an additional 500 calories and 30g of high quality protein per extra baby

Having a triplet pregnancy significantly increases your body’s demand for significantly more nutrients and energy, hence it is essential that your diet is nutritious, plentiful and adequate throughout the pregnancy.

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