Nutrition – Page 2 – Bump 2 Bab[y]ies

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:

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!

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!

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!

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.

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 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.

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!

“Let food be thy medicine and medicine be thy food.” -Hippocrates

This is a statement I passionately believe in. Medicine is defined as “the science or practice of the diagnosis, treatment and prevention of disease,” and thus nutrition is also the science of the diagnosis, treatment and prevention of disease.

This is especially true when educating and counseling persons with chronic diseases, such as diabetes, high cholesterol, high blood pressure, kidney disease and the list goes on and on. Tweaks in what these persons eat on a daily basis can dramatically improve their disease state.

Many of you are probably waiting for the link to pregnancy, well here it comes. While I continue to believe in the power of nutrition, my view of food has shifted during pregnancy. I believe food during pregnancy is very similar to food for the elite athlete; it is its most basic form- fuel.

While dietary quality is of the utmost importance during both pregnancy and athletics, but quantity often is slightly more important. I have been intrigued by the amount of energy (Calories) required to grow and sustain life, let alone 2, 3, or 6 at one time. The average adult woman needs approximately 1600 Calories per day and the average adult male needs nearly 2000 Calories per day. These amounts of course vary depending on an individual’s metabolism, body composition and daily physical activity. But, the average woman pregnant with one child needs approximately 300 additional Calories per day beginning in their 2^nd trimester. However, this is not the case with multiples. This additional energy requirement starts in the 1^st trimester and quickly escalates with each fetus:

Twins: 3,500 Calories
Triplets: 4,000 Calories
Quads: 4,500 Calories
Quintuplets: 5,000 Calories

One may be jumping for joy at this amount, because it’s like Thanksgiving everyday! Unfortunately, when you add in morning sickness, indigestion and limited belly capacity, this feat requires a bit of creativity. Again, it is important to remember that quality is a close second to quantity and thus the type of Calories consumed is also very important.

The average dietary composition is 50-55% Carbohydrate, 25-30% Fat and 15-20% Protein. During pregnancy, this also shifts to approximately 40% Carbohydrate, 40% Fat and 20% Protein. Fat, primarily from unsaturated sources high in omega 3’s, like DHA, is critical for neurological development. Protein is known as the building block for life and food sources that maintain a complete amino acid profile, animal-based proteins, are ideal. The percentage of carbohydrates decreases during pregnancy, and my assumption for this decrease is two-fold: 1) To account for the increases in necessary fat and protein and 2) To limit edema, or swelling and bloating. Carbohydrates tend to pack on water has they are stored and extra L.B.’s from fluid tend to be unappreciated, especially later in pregnancy.

Overall, we know that nutrition is an individualized science and all of the energy goals have to be adapted to the individual. I believe the best outcome for measuring a person’s nutrition during pregnancy is maternal weight gain. Future mom’s of multiples are to gain an average of 2-2.5lbs per week beginning with week one, so that by 30 weeks mama has gained nearly 80lbs. Maternal weight gain is highly associated with fetal growth and gestational age, which we know are the two variables that often influence fetal complications.

So, for you “bump” lovers out there I will be sure to post a pic or two in the coming weeks along with some updated ultrasounds. Until then, hang tight…patience is a virtue (lol). And, for you nutrition geeks and foodies out there, much like myself, there will certainly be future posts on nutrition tips and meal planning for mom’s of multiples.

Written by: Cassie Vanderwall, MS RD CD CDE CPT

Category: Nutrition

2nd Trimester here we come!

Eating for…Six