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Dietary Changes

Bullet Point It seems that most women with TTTS at mid-pregnancy are found to be malnourished. Anemia, low blood protein, decreased calorie intake and dehydration are common findings.
Bullet Point Many women with multiple gestations have morning sickness or poor appetites that may be worse than that seen with only one baby. It may be frustrating and upsetting not to be able to eat well. This below normal intake of nutrients, combined with the needs of twin babies and some of the mother's changes in TTTS (e.g., a womb that is more than twice the normal size for the time of pregnancy) may all contribute to the development of malnutrition.
Bullet Point There are two unusual circumstances in TTTS that could make a mother's weight go up despite decreasing her dietary intake. These cause inaccuracies in determinations of nutritional status when one weighs themselves on a scale:

1. When the recipient develops polyhydramnious (excess amniotic fluid), this water in the womb adds to the mother's weight.

2. The second is also water weight, but this is the effect of swelling or edema that occurs throughout the mother's body whenever her blood protein levels drop to abnormally low levels.

Bullet Point The Foundation has explored a number of ways for women to help solve this problem and found that the most efficient way to recover the losses, and prepare for the rest of the pregnancy, is to take liquid dietary supplements (e.g., Boost, Carnation Instant Breakfast, Ensure Plus, and others that are soy based) sipped slowly, continuously throughout the day in addition to whatever you can eat at meals. If the morning sickness is still present, encourage your patient to try her best with the supplements and liquids until it passes.
Bullet Point The sensation of thirst is also common, and seems unusual in the face of excess body water. We recommend soy milk or athletic drinks (e.g., Gatorade.) to provide more than just water the mom and her babies.

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