Top Ten Tips for Twin Pregnancies


photo credit: Jennie Pyfferoen photography {Nashville}

Telling a couple that they are having twins is one the best things about my job. Watching their faces as the meaning of my words takes effect is priceless. With twin pregnancies on the rise due to increased use of fertility medication and older maternal ages, I get to tell the exciting news often. Currently 3.3% of births in the US are multiples.

Luckily in this age of ultrasound technology, women usually know fairly early in their pregnancy, so they can start planning right away. Here are some helpful hints for those who are going to be needing a double stroller:

TPC’s Top 10 Tips for Twin Pregnancies

1. Eat for 3. Twin pregnancies require an additional 600 calories a day. So a 5′ 5″ women who weighs 140 at the start of her pregnancy will need about 2500 calories a day. That doesn’t mean 2 extra Snickers bars. Focus on getting your 5-7 servings of fruits and vegetables a day. Also, eat lean proteins throughout the day to help prevent hypoglycemia. A prenatal vitamin with at least 1 mg of folic acid and an iron supplement is encouraged for all twin pregnancies. Weight gain is recommended to be 37-54 pounds for a mom with an normal BMI.

2. Don’t fret your belly size. In The Pregnancy Companion, we talk a lot about worrying over your belly size. ‘Helpful’ friends and neighbors tend to constantly comment on the size of your belly. One neighbor comments you are too large, later the same day a co-worker will think you are too small. It’s also hard to not compare yourself to other preggos who are at the same point in their pregnancy. The shape of your pregnant belly really depends on your body type and how many babies you have had. If this is your first pregnancy and you are tall with a long torso and firm abs, you may not show until after 20 weeks.  If you have a short torso and this is your third baby, you may be in maternity clothes before you get out of the first trimester. Your doctor will be monitoring your size carefully, so listen to her, and not your mother-in-law.

3. Stay active as long as you can. Gestational diabetes is caused by the placenta secreting an anti-insulin hormone, so with twins you have twice the placenta and therefore an increased risk. Twins do often mean bed rest later in pregnancy, but not always.  Stay active as long as you can to help keep up your muscle tone and reduce your risk of gestational diabetes. Stay in communication with your doctor about your amount of activity. Even if your pregnancy is complicated by partial bed rest, ask your provider if you can continue yoga and pilates to help reduce back pain and hopefully maintain  muscle tone.

4. Buy Tums in bulk. Most pregnancy symptoms are amplified in twin pregnancies. Heartburn tends to be one of the worst. Often women will go directly from their first trimester nausea to heart burn.  The hormones of pregnancy cause relaxation of the valve between the stomach and the esophagus. Add in that two babies are pushing your stomach up towards your esophagus instead of just 1, and you get a wonderful burning sensation in your chest complete with disgusting sour taste in your mouth. Tums are safe in pregnancy but you will often need stronger meds, so talk to your provider if Tums isn’t holding your symptoms.

5. Lay on your side. It’s usually recommended to start sleeping on your side after 20 weeks, but with twins 16 weeks is more realistic. The growing uterus can compress your blood vessels, reducing the blood return to your heart, and making you feel weak or dizzy. Swelling may also start earlier than normal. Stay active, reduce high-salt foods and invest in compression stockings early on.

6. Prepare early. 60% of twin deliver before 37 weeks, but luckily only 10% are born before 32 weeks, where the major complications of prematurity usually occur. Schedule your baby showers early and try to have your nursery ready by 30 weeks. Have a few preemie outfits on hand, but keep the tags on all clothes since you are not sure what size they will be when you bring them home.

7. Accept all help. I know people always say this, but with twins, this is REALLY true. Start a list of things you will need: dinners, laundry, diapers. When anyone asks what they can do to help, even if you don’t think they mean it, assign them a task.  If it’s someone you don’t really want coming to your house to scrub your tub, ask for diapers. If you can in anyway afford it, budget for a housekeeper during the first 2 months postpartum. I think this goes for all pregnancies, but for twins especially.

8. Find your support system. Whether it’s your MOPS group, Sunday school, family or neighbors, know who you can count on for help. Seek out other moms of multiples before delivery to find out tips. Meet Up, Google, Facebook are all at your fingertips to find groups of moms who know what you are going through. In the Middle Tennessee area you can check out Nashpotato, an organization for parents of twins and triplets.

9. Find good resources. Those who follow the blog know that I had a twin adoption fall through. During the months that we were preparing to parent twins I read multiple books. The best was Juggling Twins by Meghan Regan-Loomis. This book is absolutely hilarious and chock full of helpful hints, from pregnancy through the toddler years.

10. Don’t let twice the babies equal twice the worry. As soon as you find out you are having twins, most of you will immediately hit Google. This will fill your mind with all the complications that can happen in twin pregnancies. Twins are high risk. Your doctor will watch you closely to make sure the babies are growing well. She will watch for preterm labor and high blood pressure. Twin pregnancies have bumpy parts and miserable moments, but 90% of twin pregnancies do make it past 32 weeks, resulting in healthy happy babies.  It’s hard not to worry, especially when you are going through complications, but twice the babies doesn’t have to be twice the worry. If you are spending your pregnancy fretting over possible complication or worrying if you will ever sleep again, pray through these 10 scriptures for fighting fear twice a day instead of just once a day.

Psalm 139:13 says,  “For You formed my inmost parts; You knit me together in my mother’s womb. . .”  That means twins too.

Moms of twins or multiples, what tips would you add to this list? If you are pregnant with twins, leave a comment and let us know how we can be praying for you!

Companion Books

For more tips and peace-filled advice like this, check out The Pregnancy and Baby Companion books

About Dr. Heather Rupe

Dr. Rupe is a mom, wife and OB/GYN. She is the co-author of The Pregnancy Companion book and blogs at Her heart is to help guide women through as peaceful a pregnancy as possible. In her spare time she loves to run and laugh whenever she can.


  1. Expecting twins – due in November! We just had our 18 week anatomy scan yesterday and so far all looks great! My biggest prayer request is my struggle with fear, my pregnancy before this ended at 27 weeks with an unexplained loss of our precious daughter.
    Thank you so much for your book, fb page and this blog! These resources have helped me countless times!

  2. Its really helpful for my sister who is pregnant. Good to read it. Thanks

  3. I’m 19 years old and 11 weeks pregnant with Twins Im so Scared been on the internet like crazy since I found out 12-12-12 this really helps thanks

    • Hi Terressa, So glad to have connected with you here. It can be scary to read lots of things on the internet. Just remember that God is the creator of life and he loves you and those babies. Blessings to you!

  4. Hello! I am expecting b/g twins Feb 2013. I have a scheduled c-section at 38 weeks. I have searched and searched the internet for information since I don’t know many people with twins to get information from. I already have a 19 month old son. So my biggest prayer request is that tending to him doesn’t put me into labor earlier than I should and that the delivery will be a healthy one for the twins and me =) Thanks!

  5. Drink plenty of water and don’t overdo. Currently 26 weeks pregnant with twins and I feel better when I stay hydrated. I also work 40 hours a lot if that time on my feet and have a 3 year old. Rest on lunch breaks, nights, and weekends…your body will thank you for it!

  6. esi hagan says:

    pregnant with twins

  7. Yes…stay active but then towards the second half, don’t hesitate to rest. Lots of unofficial bedrest was key…I think for me at least…in going full term.

  8. I just found out today at my 5 week scan (I had a small bleed so got rushed for an emergency scan) that I’m pregnant with twins. I’m over the moon and hoping both little babies are stronger and have little beating hearts next time I see them. Only 18 days to go and counting with all fingers ans toes crossed.

  9. Krystle Suggs says:

    Almost 9 weeks pregnant with twins, everything looks great, I go back at 11 weeks for another scan, and again at 12 weeks for the early genetic testing and scan at the perinatologist. Each baby has their own sac, and we will find out soon if they have their own placentas as well. My husband is very supportive of me doing everything I need to stay healthy and have healthy babies, and I also have an almost 13 year old son and an 11 year old daughter that help me tremendously with house chores and my 13 month old daughter. My biggest prayer request is that we make it past 32 weeks with no complications, Google is terrifying. The diapers thing is a genious idea, and I will definitely get on that right away. This blog is a blessing. Thanks
    Krystle Suggs
    Due: 2/11/2015 with my Twinkie beans.

  10. I am currently just 12 weeks pregnant with twins! Not sure if they are monochorionic or not yet, but I go in for an ultrasound tomorrow to find out. I could not be more excited. I really enjoyed reading this blog. I didn’t have many worries until everyone started asking me, “What are you going to do about this? and “How are you going to do that?” and “Do you have to get a new car?” And now the fear is kicking in! But I am still really excited and ready for the challenge. It’s so awesome to see positive thinking and helpful words of encouragement, so thank you!

    Abby Mills
    Due 1/25/2015

  11. I’m 30 weeks along and found out just last week that my transverse baby wasn’t the only reason I was measuring large. (We birth at home and try to keep things natural so last week was my first ultrasound even though this is my 6th pregnancy). Please keep us in your prayers through this new pregnancy adventure. We are expecting a boy and a girl in late September. Please pray that we maintain a healthy pregnancy for these last weeks.

    • Heidi, how exciting! Praying for you as you look towards this new adventure!! Praying for a healthy pregnancy as you look towards this birth. And praying for a wonderful birth experience!!

  12. Biresh.singh says:

    My wife is pregnant with twin and she is very weak so i worried about it. So please sugges me what to do pregnancy continue or not.

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