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

item GANDHI, MANISHA - Baylor College Of Medicine
item GANDHI, RAJSHI - Baylor College Of Medicine
item MACK, LAUREN - Baylor College Of Medicine
item SHYPAILO, ROMAN - Children'S Nutrition Research Center (CNRC)
item ADOLPH, ANNE - Children'S Nutrition Research Center (CNRC)
item PUYAU, MAURICE - Children'S Nutrition Research Center (CNRC)
item WONG, WILLIAM - Children'S Nutrition Research Center (CNRC)
item DETER, RUSSELL - Baylor College Of Medicine
item SANGI-HAGHPEYKAR, HALEH - Baylor College Of Medicine
item LEE, WESLEY - Baylor College Of Medicine
item BUTTE, NANCY - Children'S Nutrition Research Center (CNRC)

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/12/2018
Publication Date: 10/12/2018
Citation: Gandhi, M., Gandhi, R., Mack, L.M., Shypailo, R., Adolph, A.L., Puyau, M.R., Wong, W.W., Deter, R.L., Sangi-Haghpeykar, H., Lee, W., Butte, N.F. 2018. Estimated energy requirements increase across pregnancy in healthy women with dichorionic twins. American Journal of Clinical Nutrition. 108(4):775-783.

Interpretive Summary: Additional food intake providing 340 kilocalories per day and 452 kilocalories per day are needed at 22-24 weeks of pregnancy and at 30-32 weeks of pregnancy, respectively, in order to yield healthy outcomes in normal-weight women carrying a single baby during pregnancy. The food intake needed among women with twin pregnancy is not known. To measure the additional food intake for twin pregnancy, 24 healthy women carrying twins were enrolled at 11-13 weeks of pregnancy while 20 completed the study. In the study, changes in body fat and muscle mass as well as the amount of energy (calories) consumed were measured at 22-24 weeks and 30-32 weeks of pregnancy and within one week after delivery of the babies. The study showed that an additional energy intake of 700 kilocalories per day were needed at 22-24 weeks and at 30-32 weeks of twin pregnancy. The additional energy intake required was not different between normal weight and overweight women. The study represents the first to document the additional food intake required for twin pregnancy using state-of-the-art methods.

Technical Abstract: 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. 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. 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. 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. 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.