Double Time

It’s double time!  For those bandies and musicians or Tae-bo pros out there, you know this means it’s time to pick up the pace.

During the 2nd trimester, from weeks 15 to 20, babies double in size. So, you can imagine that the nutrient needs of both mom and babies alsoescalate. There are a variety of methods to determine how many calories are ideal during pregnancy. There are estimated energy requirement equations, some just say 300 extra calories and 30 extra grams of protein per day, and others encourage moms to add 500 calories per fetus and 25g protein. I, personally, think it is best to consume the amount of calories that promotes the ideal weight gain per week. For a mom of high order multiples it is 2.0-2.5 lbs. per week.

I was able to gain this at 3,000 Calories per day during the first trimester. This was a true blessing because with the nausea there was no way I was going to get to the original 5,000-calorie estimation. During weeks 13 to present, I have watched this weight gain slow-down, so I know it’s time to bump up the kCals. I really was quite surprised that there were not any meal plan examples- that I could find anyway- on the Internet. My best resource was in Dr. Barbara Luke’s book, “When you’re expecting twins, triplets, or quads.” This is where I derived the information regarding calorie and food group goals. Since there seems to be a gaping whole on the World Wide Web, I thought I’d go ahead and fill it.

Below you will find recommendations for calories, macronutrients (carbs, protein and fat) and suggested food group goals during pregnancy. While this information is targeted at high order multiple pregnancies, it is of course applicable to any pregnancy.

Calories goals may vary from 3,000-5,000 Calories per day, and I recommend watching your average weight gain from week-to-week to be sure you are getting enough. The composition of these Calories is important and different than the recommendations for the average American. Typically, it is recommended to consume a daily diet composed of 50-55% calories from carbohydrate, 15-20% calories from protein and 25-30% calories from fat. However, during pregnancy with super twins it is recommended to consume 40% of calories from carbohydrate, 40% calories from fat and 20% calories from protein. The reduction in calories from carbohydrate, I presume is to decrease one’s risk of gestational diabetes, which is much higher in pregnancies with 3 or more. Per Dr. Luke, this breaks down to the following:

Nutrients

3,000

3,500

4,000

4,500

Protein

 150g

176g

200g

225g

Fat

 133g

155g

178g

200g

Carbohydrate

 300g

350g

400g

450g

Food Groups

Servings per day

Lean Protein

4

5

5

6

Dairy

4

8

10

12

Grains

8

10

12

12

Fat

5

6

7

8

Fruit

7

7

8

8

Vegetables

4

4

5

6

This type of meal plan is quite different than my pre-pregnancy diet, so my typical pattern is a bit different. For example, prior to pregnancy I ate very little dairy and meat/poultry and the majority of my protein came from beans, peas, lentils, whole grains, and fish. It has been easiest for me, and my mild lactose intolerance, to add the lean meats versus 8-10 servings of dairy per day.  Also, before pregnancy I ate a lot of veggies and not so many fruits, so I continue to consume only 2-3 fruits per day and 8-plus servings of vegetables.

As mentioned previously, I have been consuming 3,000-3,500 Calories per day so I decided to share a few meal plans, or as RD’s call them “Typical days” to help make these recommendations real.  There are a few original high calorie, high protein recipes in the meal plans that I will add later. If you’re interested check back because I will be adding a recipe section to my blog. Also, I did not comment on the variety of supplements that I believe are a crucial safety net, so look out for that content coming soon!

Day 1

(3,065 Calories: 316g Carb, 92g Fat, 175g Protein)

Breakfast

  • Breakfast Taco Dip
    • ½ tsp Olive Oil
    • 1 Organic Egg
    • ½ Avocado
    • 4oz 0% Plain Greek Yogurt
    • Lentil Loaf (Recipe coming soon)
    • 2 Hard Shell Tacos, broken into chips
    • Up Your MassBanana Smoothie (Recipe coming soon)

AM Snack

  • Fruit and Yogurt Parfait with Granola
    • ½ cup Fresh berries
    • 1 cup Low-fat Vanilla yogurt
    • ¼ cup Nutty Granola

Lunch

  • Turkey and Avocado Sandwich
    • 2 slices Homemade Whole Wheat Bread
    • 3 oz Oven-roasted Turkey Breast*
    • ½ Avocado
    • 1 cup Fresh Spinach
    • 2 Clementines
    • ½ Cup Baby Carrots

PM Snack

  • Oat and Nuts Cereal
    • 1 ¼ C Oat Cereal
    • 1 C Unsweetened, Organic Soy Milk
    • ¼ C Roasted Pepitas
    • ¼ C Slivered Almonds

Dinner

  • Basil Mac & Cheese (Recipe coming soon)
  • 12 medium shrimp, cooked
  • 1 C Asparagus Spears
  • Skinny Cow Ice Cream Sandwich

Evening snack

  • PowerBarHarvest Peanut Butter Chocolate

Day 2

(2,993 Calories: 319g Carb, 94g Fat, 171g Protein)

Breakfast

  • 4 Up Your MassBanana Nut Pancakes (Recipe coming soon)
  • 1 C Unsweetened, Organic Soy Milk

AM Snack

  • Cinnamon Raisin Bagel with 1oz Cream Cheese
  • 1 C 2% Milk

Lunch

  • 1 Large Baked Potato with Lentil Loaf, melted Cheese stick and 2 Tbsp Salsa
  • 1 C Asparagus spears
  • 1 C Fresh Pineapple

Dinner

  • ¾ C Cooked Quinoa with 1 tsp Olive oil
  • 4oz Organic, Skinless Chicken Breast
  • 1 C Steamed Zucchini Squash
  • Skinny Cow Ice Cream Sandwich

 

Day 3

(3,710 Calories: 367g Carb, 154g Fat, 176g Protein)

Breakfast

  • Stuffed Baked Potato
    • 1 Large Baked Potato
    • ½ tsp Olive Oil
    • 1 organic Egg and 1 Egg white
    • 1 Melted Cheese stick
    • ¾ C Kidney Beans
    • ¼ C Salsa

AM Snack

  • ¼ C Dried Fruit
  • ½ C Almonds and Pumpkin seeds, mixed
  • 1 C Organic Skim Milk

Lunch

  • ¾ C Pasta with ½ C Meat Tomato Sauce and ¼ C Melted Mozzarella Cheese
  • 1 C Steamed Spinach
  • 1 Banana
  • 2 Tbsp Peanut Butter

PM snack

  • 1 Whole Wheat Pita
  • ½ C Original Hummus

Dinner

  • 5 oz Salmon with ¼ C Avocado Salsa
  • 1 C Wild and Brown Rice
  • 1 C Steamed Broccoli

Evening Snack

  • 1 ½ C Neapolitan Ice Cream**

* I try not to consume deli meat, so this was a baked turkey breast. I do reheat any lunch meat/protein that I bring as a food safety precaution.

** When you want to promote glycemic (blood sugar) control, eating sweets and desserts alone is a no-no. However, if the dessert is consumed within 1 hour of a meal or healthier snack, typically the blood sugar response is more favorable.

Written by: Cassie Vanderwall, MS RD CD CDE CPT

2nd Trimester here we come!

We are all happy, healthy and going strong at 12 weeks and counting! Today we had our 2nd consultation with our perinatologists and this meeting was much more uplifting than the previous. It was a balanced discussion of impending risks, as well as, strategies to promote a healthy gestation. It appears that there is little medical intervention prior to 20-24 weeks. I, however, recognize that there is a lot I can do to help us all get to that 6 month milestone- the viability period.

My personal mission in the next 2-3 months is three-fold:

12 week bump

12 week bump

1) Gain weight. Researchers have published that women who have gained 75% of their total weight by 24-weeks have longer gestation periods. This means I have 40lbs to gain in the next 3 months, so I’m all stocked up on high calorie, high protein recipes and don’t forget my Up Your Mass Powder. I’ll most likely share my meal plan in the next few weeks for other mom’s of high order multiples.

2) Stay active as safely as possible. All that I have read encourages 30-minutes of aerobic exercise daily. I have been practicing this on “good” days  and I have to admit, it definitely is energizing and I even think it helps to combat the nausea a bit. I have also read that hydrotherapy is especially beneficial later on in pregnancy, so I plan on incorporating that as soon as I’m brave enough to buy a maternity bathing suit. I believe the more difficult achievement will be to practice bed rest when it comes time. I have to say I have been better at “taking it easy” than anticipated…I think it helps that I have 5 very important reasons to chill-out.

3) Continue to be a student of my body and our babies. I believe it will be important for me in the later months to be able to monitor and measure contractions, and currently I am not quite sure I know what those feel like. The doctors assure me that I will know them when I feel them. Some literature that I have read said that it is important to keep background contractions at less than 3.5 minutes apart. We’ll see how this all plays out.

Enough about me…on to those babies!

V-5 Family Photo

V-5 Family Photo

The second part of our visit today was focused on completing the 1st trimester screening which included anatomical assessments, heart rate assessments, nuchal scans, and numerical assignments. Overall, everyone is right on track. They are all just shy of 2.5 inches long, have all 4 limbs and strong heart beats between 150-155bpm. Also, the nuchal scan is an assessment of the thickness of the skin on the back of the baby’s neck. Greater thickness (> 2-3mm) is correlated with an increased incidence of congenital heart defects and Down syndrome. All of our little ones’ nuchal scans were <2 mm! They were also able to number each placenta for good, or so they are hoping. Based on the photo above, number 1 is on the bottom right, number 2 is in the center row on the right, baby 3 is to the left of baby 2, baby 4 is just below baby 3 and to the left of baby 1, and baby five is the cherry on top! All 5 have a distinct location, but have shifted a bit since the last ultrasound to provide themselves more room for growth. The ultrasound technician said that the placement of all of the placentas look great!

Cue “Eye in the Sky” by the Alan Parsons Project (a.k.a. the Chicago Bulls Intro Song)

And now all the way from Madison, Wisconsin, 12-weeks and 2.5 inches long the Vanderwall quintuplets!

When we were introduced to baby 1 at this visit, their little hand was right up to its ear, just like it was chatting on the phone. Our technician said it was probably calling the others to let them know Mom and Dad were watching :O) We deemed this one both our chatterbox and tattletale!

Baby 1

Baby 1

The next stop was to the three arranged in the middle. Starting from right to left: baby 2. It’s difficult to tell from the photo, but this one we think is going to be the tough cookie of the bunch. They had their fists raised just like a boxer and were kicking their legs like crazy. Little did we know, but those little legs were right up against baby 3’s placenta. We think we got to witness an epic battle of footsie!

Baby 2

Baby 2

Moving to the left, the monkey in the middle, baby number 3. This little one couldn’t sit still for a moment. They looked like they were break-dancing with an impressive worm.

Baby 3

Baby 3

On the far left, is baby number 4. Who appeared to be the most mild mannered of the bunch. They were chillaxin’ with their little legs propped up and ankles crossed. They moved a little, but looked quite content watching the others.

Baby 4

Baby 4

Baby number 5 was previously the baby they were most concerned about because they had nestled in near to the opening of the fallopian tube. They also were lagging a bit in growth last time we checked in. But, this time they scooted over a bit and have plenty of room to grow and they are tracking beautifully on growth. They are still the shortest of the bunch, but what they currently lack in length they make up for upstairs. The technician said this one had a beautiful brain! So, we’ve got a shorty with some smarty pants.

Baby 5

Baby 5

And those, folks, are the V-5! The next time we will get to see them is at 20 weeks! That is also when we will be able to assess their genders. So, please keep the prayers and positive thoughts flowing because these kiddo’s and their Mommy and Daddy have their eyes set on 34 weeks!