Weight Gain With Twin Pregnancy

Pregnant woman using digital tablet at home
Vesnaandjic / Getty Images

It's common to be concerned about the amount of weight you will gain during pregnancy. As you might suspect, when you are having multiples you'll see more of an increase on the scale than if you were only having one baby.

It's not just that you're eating more. The extra weight can be attributed to the babies' combined weights as well as extra fluid, tissue, uterine growth, and the increased blood volume needed to supply the placenta(s) with nourishment for two or more babies.

Guidelines for Twin Pregnancy Weight Gain

In 2009, the Institute of Medicine introduced guidelines created by Dr. Barbara Luke for weight gain during twin pregnancies. Dr. Luke is a Michigan State University professor who led a research study of more than 2,000 twin pregnancies, and the results of her study served as the basis for the IOM guidelines.

The study evaluated maternal weight gain and fetal growth to develop models of optimal weight gain based on a person's pre-pregnancy body mass index (BMI). These are still the most current weight gain recommendations for twin pregnancies.

Pregnancy Weight Gain Guidelines

If you are pregnant with twins, the amount of weight you should gain will depend on your starting weight.

  • Healthy, normal-weight mothers (BMI 18.5–24.9): 37–54 pounds
  • Overweight mothers (BMI 25.0–29.9): 31–50 pounds
  • Obese mothers (BMI 30.0 or greater): 25–42 pounds

To determine your BMI, check out the Centers for Disease Control and Prevention's BMI calculator.

Previous weight gain guidelines did not take into account the mother's weight prior to pregnancy. Although these current guidelines are divided by weight categories, some doctors have criticized them for including weight goals that are too high for overweight or obese women.

Data from the CDC shows that almost half of expectant mothers gain weight above the recommended range, putting them and their babies at risk of weight-related health issues.

The American College of Obstetricians and Gynecologists advises women to talk to their doctor about a lower weight gain goal if they are overweight or obese and their babies are showing adequate prenatal growth.

Body Mass Index (BMI) is a dated, biased measure that doesn’t account for several factors, such as body composition, ethnicity, race, gender, and age.

Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.

Why Appropriate Weight Gain Is Important

Generally, a healthy pregnancy requires that a person gain 25 to 35 pounds during the nine-month gestation period. But that's for just one baby. Like everything about having multiples, more is required. In most cases, about a third of the weight belongs to the babies.

Most people gain about 35 to 50 pounds during a twin pregnancy, with about 10 additional pounds for every additional baby in a higher-order multiple pregnancy.

Although the thought of gaining weight can be daunting, it's vitally important for the health of the babies, and for you also. It takes an incredible amount of energy to sustain a twin or multiple pregnancy.

However, keep in mind that the goal is to gain weight within the recommended range, not too much or too little. The amount of weight that you gain during pregnancy will affect both your health and that of your babies. In addition, gaining too many pounds can make it harder to lose the baby weight after delivery.

Infants born to mothers who do not gain enough weight during pregnancy are at higher risk of pre-term birth and low birth weight. They may also be more susceptible to illnesses and breastfeeding problems.

In contrast, women who gain too much weight experience more delivery complications (including c-sections) and have babies who are at risk of childhood obesity.

Rate of Weight Gain in Twin Pregnancy

The rate of weight gain during pregnancy varies with each trimester, depending on a variety of factors such as how fast your babies are growing, how much fluid you're storing, and of course, how much you're eating and exercising.

It's important to eat a healthy diet throughout pregnancy, in order to provide all of the nutrients that your body needs for the enormous task of supporting two growing babies.

In the first trimester, a weight gain of about one-half to one pound per week is appropriate for most women.

This may not seem like much, but even that amount can be a challenge if you're dealing with the additional nausea that often comes with a twin pregnancy. When you have double the babies, you also have double the hormones, and this leads to increased morning sickness for some women.

Through the second and third trimesters, a weight gain of 1.5 pounds per week is appropriate for most women until the eighth month, when weight gain begins to taper off until your due date.

Tracking Your Pregnancy Weight Gain

The Centers for Disease Control and Prevention provides a printable weight gain tracker for twin pregnancies. The chart makes it easy to record your weight gain each week and make sure it's in the healthy range.

What to Eat For Healthy Weight Gain

While your pregnancy calorie needs will depend on your pre-pregnancy weight, the general guidelines for women at a healthy weight recommend a daily intake of 3,000–3,500 calories during twin pregnancies.

During your first trimester, follow these tips to keep morning sickness at bay and maintain a healthy rate of weight gain:

  • Sip nutrient-rich liquids such as vegetable and fruit juice, bone broth, or smoothies. Just make sure your juice and smoothies aren't of the sugar-laden variety.
  • Eat five to six small meals and snacks throughout the day, as opposed to two or three large meals.
  • Try cold or room-temperature foods; the smell and taste of hot foods can increase nausea for some people.

Don't forget to take your prenatal vitamin. If that makes you queasy, try switching to a different brand or flavor. And if you can't keep any food or liquid down, be sure to tell your doctor.

In the second trimester, you will hopefully be feeling well and enjoying more energy than you did in the first weeks of your pregnancy. Take advantage of this time to fit in some regular exercise and follow a healthy diet that is high in protein and calcium with plenty of whole grains, fruits, and vegetables.

If heartburn becomes an issue toward the end of your pregnancy, you may need to go back to small, frequent meals again, and be sure to avoid any foods that trigger heartburn for you.

A Word From Verywell

Pregnancy with twins can be a time of emotional ups and downs as you prepare for your babies' arrival. Don't let these weight guidelines become a source of worry. Just know that they can help you stay focused on making wise food choices, exercising, and gaining the appropriate amount of weight to ensure that you have a healthy pregnancy and help your infants get off to a good start.

5 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Weight gain during pregnancy.

  2. Luke B, Hediger ML, Nugent C, et al. Body mass index--specific weight gains associated with optimal birth weights in twin pregnancies. J Reprod Med. 2003;48(4):217-224.

  3. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 548: Weight gain during pregnancy. Obstet Gynecol. 2013;121(1):210-212. doi:10.1097/01.aog.0000425668.87506.4c

  4. Bodnar LM, Himes KP, Abrams B, et al. Gestational weight gain and adverse birth outcomes in twin pregnanciesObstet Gynecol. 2019;134(5):1075-1086. doi:10.1097/AOG.0000000000003504

  5. Whitaker KM, Baruth M, Schlaff RA, et al. Provider advice on physical activity and nutrition in twin pregnancies: A cross-sectional electronic survey. BMC Pregnancy and Childbirth. 2019;19(1):418.

Additional Reading
  • Luke B, Eberlein T. When You’re Expecting Twins, Triplets or Quads (3rd Edition). New York: HarperCollins Publishers; 2011.

By Pamela Prindle Fierro
 Pamela Prindle Fierro is the author of several parenting books and the mother of twin girls.