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.
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.
There are two unusual circumstances in TTTS that could make a mother's weight go up despite decreasing your 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 your blood protein levels drop to abnormally low levels.
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 your
best with the supplements and liquids until it passes.
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 your babies.
Adrianna and Sophia
In his ongoing research, Dr. De Lia has found the majority of TTTS mothers to be severely malnourished and anemic. He also explained the details of in-utero placental laser surgery. When we concluded our conversation, we felt we had a new plan to save our babies, along with a very determined knowledgeable man on our side. That day I started complete bed rest and a higher protein, high calorie diet. It was wonderful having potentially life saving knowledge for our babies. Our precious daughters, Adrianna Grace and Sophia Antoinette, were born on November 4, 2002. We are truly blessed.
Terri Ann, mother to Adrianna and Sophia