Estimated energy requirements increase across pregnancy in healthy women with dichorionic twins

Am J Clin Nutr. 2018 Oct 1;108(4):775-783. doi: 10.1093/ajcn/nqy184.


Background: Estimated energy requirement (EER) has not been defined for twin pregnancy. This study was designed to determine the EER of healthy women with dichorionic-diamniotic (DCDA) twin pregnancies.

Objectives: We aimed to estimate energy deposition from changes in maternal body protein and fat; to measure resting energy expenditure (REE), physical activity level (PAL), and total energy expenditure (TEE) throughout pregnancy and postpartum; and to define the EER based on the sum of TEE and energy deposition for twin gestation.

Design: This is a prospective study of 20 women with DCDA twin gestations. Maternal EER, energy deposition, REE, TEE, and PAL were obtained during the first, second, and third trimesters of pregnancy and immediately postpartum. A mixed-effects linear regression model for repeated measures with random intercept was used to test for the effects of BMI groups and time.

Results: Gains in total body protein (mean ± SD: 2.1 ± 0.7 kg) and fat mass (5.9 ± 2.8 kg) resulted in total energy deposition of 67,042 ± 25,586 kcal between 0 and 30-32 weeks of gestation. REE increased 26% from 1392 ± 162 to 1752 ± 172 kcal/d across the 3 trimesters, whereas TEE increased 17% from 2141 ± 283 to 2515 ± 337 kcal/d. Physical activity decreased steadily throughout pregnancy. Reductions in physical activity did not compensate for the rise in REE and energy deposition, thus requiring an increase in dietary energy intake as pregnancy progressed. EER increased 29% from 2257 ± 325 kcal/d in the first trimester to 2941 ± 407 kcal/d in the second trimester, and stayed consistent at 2906 ± 350 kcal/d in the third trimester.

Conclusion: Increased energy intake, on average ∼700 kcal/d in the second and third trimesters when compared with the first trimester, is required to support gestational weight gain and the rise in energy expenditure of DCDA twin pregnancies.

Publication types

  • Twin Study

MeSH terms

  • Adipose Tissue / metabolism
  • Adult
  • Basal Metabolism
  • Body Mass Index
  • Energy Intake*
  • Energy Metabolism*
  • Exercise
  • Female
  • Gestational Age
  • Gestational Weight Gain*
  • Humans
  • Nutritional Requirements
  • Postpartum Period
  • Pregnancy
  • Pregnancy Trimesters*
  • Pregnancy, Twin / metabolism*
  • Prospective Studies
  • Proteins / metabolism
  • Reference Values
  • Twins, Dizygotic*


  • Proteins