Dr. Barbara Luke, an MPH, reproductive epidemiologist, nurse, nutritionist, and author of a book on expecting twins, joined Dr. Fox to discuss prenatal nutrition in twin pregnancies. “For me, prenatal nutrition is the most preventive medicine you could do,” said Dr. Luke. In this blog, we discuss her professional background, research, findings, and more.
Dr. Luke received her undergraduate degree in nursing from Columbia University. After graduation, she went into the Visiting Nurse Service and performed public health nursing in the South Bronx and Lower East Side of New York. After some time, she decided to pursue her master’s degree in foods and nutrition at NYU and became a registered dietician. She then approached Columbia Presbyterian to start a prenatal nutrition program, which is now the Supplemental Nutrition Assistance Program (SNAP).
Dr. Luke noticed when it came to pregnancy, many things could be measured such as weight gain, someone’s diet, and blood glucose levels. However, she found that there were no guidelines for women who were pregnant with twins. This was a problem, because, while some women naturally grew and birthed twins easily, others struggled.
She decided to return to the literature on the subject and found that most twins were born small or premature. She chose to perform some pilot studies and eventually went on to receive her doctorate in perinatal epidemiology and reproductive epidemiology at John Hopkins University. She investigated a decade of twin births in Baltimore. But while 10 years’ worth of twins was enough for a dissertation, it was not enough for research.
To combat this issue, Dr. Luke formed a consortium around the country of people interested in multiple births, which included four universities. All data regarding every aspect of multiple pregnancies was collected including ultrasound cost, length of stay, weight gain, placental pathology, labs, etc. What started as just a couple of hundred twin births ended up being 3,600 with comprehensive data on all different aspects. Dr. Luke and her consortium published a great deal of research based on this data.
Dr. Luke and her teams also looked at pregnancies that ended with nice big, healthy children, about 6.5 to 7 pounds each for twins born at 37 to 39 weeks without complications. They decided to track backward what these women weighed before they were pregnant and modeled the data to see how much they gained by each trimester. They found that, from conception to 20, and 20 to 28 are the most critical periods for fetal growth. After 28 weeks, how much weight a woman gains does not make as big of an impact. Dr. Luke stated that she was particularly proud of this piece of research, as the National Academy of Sciences and the Institute of Medicine took it as the first national recommendation for weight gain in twin pregnancies.
The research teams found that women who gained weight earlier during pregnancy were more likely to give birth to larger, healthier twins. “The early weight gain makes a good placenta and expands the blood volume,” explained Dr. Luke. “It’s like a garden. If you’re getting everything ready, growth is going to take off. And that’s what we saw…If you can keep them growing well, as long as possible, you’re going to have nice-sized mature babies at birth.”
This directly combatted the research Dr. Luke came across early in her studies regarding the normalcy of twins being both small and premature. She believes that every child has the potential to grow large and healthy with the right nutrition.
Now armed with this research-backed knowledge, Dr. Luke shares her findings with patients. However, one issue that she commonly comes across is women feeling uncomfortable gaining weight during pregnancy. Many women try for years to avoid putting weight on, but when faced with a twin pregnancy, must change their mindset for the health of their babies.
Dr. Luke also found studies that supported breastfeeding following twins is recommended not only for the health of the children but also to help get the mother’s metabolism on track. Because of this, she recommends breastfeeding to mothers, which can also help them lose pregnancy weight quicker.
Dr. Luke has also partnered with professional writer, Tamara Eberlein, who herself had twins. While the first edition was only 200 pages, they are now on their 5th edition, which has grown to 650 pages.
When asked to describe the book, Dr. Luke called it a “common-sense recipe.” She picked the best evidence regarding nutrition and what is proven to work for women. One commonly researched diet is the diabetic diet, which works by balancing blood sugar levels. Because diet heavily influences blood sugar levels, this diet can help support fetal growth.
Dr. Luke also found that protein was an important factor in the babies’ fetal tissue. She observed that her vegetarian patients did not do as well as those who ate meat and drank milk. Vitamin D, Folic Acid, and Omega-3 are also important supplements to support fetal development.
At Maternal Fetal Medicine Associates, the team recommends that all women with twins see a nutritionist formally. Dr. Luke believes that this is an important step to help the mother find a diet plan that is filled with nutrient-rich foods that will work for her. Nutritionists can make helpful recommendations to meet the mothers’ caloric and nutrient needs.
Overall, Dr. Luke believes that nutrition is the key to helping grow healthy twins. “There’s a reason children should be born nice, big, and healthy,” she said. “They start their life with the complement of healthy organs to begin a healthy life, and that nutrition is really at the heart of all of that.”
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!