Prenatal Vitamins During Twin Pregnancy

Prenatal Vitamins During Twin Pregnancy
I’m having two babies, should I be taking TWO prenatal vitamins?
  • No, as a mother of twins you should be taking one quality prenatal vitamin every day.
  • For mothers of twins, The Society of Maternal-Fetal Medicine has the following specific nutritional recommendations:
    • 1 mg folic acid daily throughout twin pregnancy.
    • 30 mg iron daily throughout twin pregnancy.
Why is folic acid important?
  • Folic acid is super important to your baby’s neural development (brain and spinal cord) and prevents serious birth defects such as spina bifida (myelomeningocele). Spina bifida is a condition where the spinal cord is not fully fused at birth leaving the spinal cord exposed on the outside of the baby’s body. This condition can yield devastating complications such as paralysis, hydrocephalus (fluid on the brain), bladder and bowel incontinence, and decreased sensation of the lower extremities.
  • My husband Steve was born with myelomeningocele and represents an extremely rare and lucky outcome of this devastating disease. When he was born and the doctor realized the diagnosis, Steve was immediately air lifted to a more advanced hospital system for emergency neurosurgery. He then underwent numerous surgeries in childhood and thanks to the great doctors and nurses who cared for him has emerged virtually unscathed (although sometimes during typical husband/wife banter I question this and like to joke that he must have some residual cognitive impairment haha). The positive interactions with nursing staff during these childhood surgeries ultimately inspired him to enter the field of nursing and to work to make a difference in the lives of other kids by working in the Children’s Emergency dept. where we live. See below shameless plug about Steve who I am super proud of!  Steve Smith, RN
How much folic acid is in the average prenatal vitamin?
  • Depending upon the prenatal vitamin, it ranges between 0.4 mg-0.8 mg.
Where do I get the extra 0.2 mg of folic acid if I’m supposed to have 1mg and the prenatal vitamin only has 0.8mg?
  • Unless instructed to take extra folic acid by your OB, you can typically get adequate supplementation from one daily prenatal vitamin. I would recommend taking a prenatal vitamin containing the higher end of folic acid (0.8mg) and then by simply eating a regular diet with folic acid containing foods you should get more than a sufficient amount of folic acid/day.
    • Folic acid is found in many everyday foods like breakfast cereals, leafy veggies, citrus fruits and beans.
What about iron?
  • Like folic acid, iron is supplied in sufficient amounts by your prenatal vitamin. Dietary intake can also boost your iron stores and help prevent iron deficiency. Iron can be found in meats (beef, chicken, turkey, pork), beans, and many iron-fortified cereals.
  • Women with twin pregnancy are at increased risk of developing iron deficiency anemia. 1
    • Symptoms of IDA (iron deficiency anemia) can include feelings of weakness, fatigue, headache and exercise intolerance; the problem is of course all of these symptoms are associated with a completely normal pregnancy and can even be amplified in a normal twin pregnancy. This is why your OB will check your “H & H” (hemoglobin and hematocrit) and screen you for iron deficiency anemia in your first and third trimester with a simple blood test.
  1. Chasen ST, Chervenak FA. Twin Pregnancy: Prenatal issues. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2016.
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