Individualized nutritional guidance and monitoring in multiple pregnancies is particularly important to ensure maternal and fetal health and to reduce the incidence of perinatal comorbidities and complications. It is important to understand the nutritional requirements of multiple pregnancies, the nutritional management of complications in multiple pregnancies and the way to manage multiple pregnancies during pregnancy. In recent years, there have been more domestic nutritional studies on singleton pregnancy, but fewer nutritional studies on multiple pregnancies, which have both similarities and differences, and this article focuses on the nutritional management of multiple pregnancies during pregnancy. 1, the nutritional requirements of multiple pregnancy (1) energy, multiple pregnancy than single pregnancy energy reserves and demand are increased, so need to intake more energy to meet the needs of pregnancy, to achieve appropriate weight gain, to ensure the normal growth and development of the fetus. Different calorie supply should be given according to the age, body mass index, occupational nature and labor of the pregnant women. In the dietary treatment research on twin and triple pregnancies, it is found that the proportion of protein, carbohydrates and fat in the daily diet each accounts for 40%, 30% and 30% respectively, which is more appropriate. (2) Trace elements and vitamins The influence of trace elements and vitamins on the growth and development of the fetus has been gradually emphasized in recent years, and such substances play a vital role in the normal metabolism of pregnant women, the growth and development of the fetus and its immune function, as well as the maintenance of the body’s health status, etc. The lack of certain trace elements will directly affect the outcome of pregnancy and the health of the mother and child, and a decrease in vitamins will also have a negative effect on the ideal birth weight and overall health level of the newborn. Reductions in vitamins can also adversely affect ideal birth weight and overall neonatal health. Under normal dietary conditions, true deficiencies of micronutrients during pregnancy are uncommon, and deficiencies occur only when there are insufficient mineral reserves in the body before pregnancy and insufficient supply after pregnancy. Nutritional management of complications in multiple pregnancies Multiple fetuses cohabit in the mother’s uterus during multiple pregnancies, sharing a narrow space for movement and limited nutritional resources from the mother, and the types of complications and comorbidities that occur during the perinatal period cover most obstetric comorbidities, with a significantly higher incidence than in singleton pregnancies. (1) Gestational vomiting and gastrointestinal symptoms during pregnancy Gestational vomiting is a disease at the intersection of obstetrics and internal medicine, and is mostly thought to be closely related to increased blood HCG. In multiple pregnancies, pregnant women’s blood HCG value increases significantly, so the incidence of emesis is high and the symptoms are often more severe than in single pregnancies. Because of its unknown etiology and concerns about medication use in early pregnancy, symptomatic supportive treatment is mainly used in clinical practice. Patients with severe disease should be hospitalized for supportive treatment. Parenteral nutrition by subclavian central venous puncture and enteral nutrition by nasoenteric tube and nasogastric tube are more effective, but the acceptance of both methods is poor, and subclavian central venous puncture may lead to infection. Peripheral intravenous nutrition with fat milk and albumin for the treatment of severe vomiting of pregnancy has high patient acceptance and is safe to use, with fewer complications and adverse reactions, and the rate of symptomatic relief, time to relief, and time to conversion of urinary ketone bodies are significantly earlier than those who don’t use or use conventional rehydration fluids, simple supplementation of energy combinations, and compounded amino acids, which is worthy of being promoted in the clinic. Women with multiple pregnancies usually experience heartburn more frequently than pregnant women with a single pregnancy due to the rise of the enlarged uterine fundus, which presses near the stomach and interferes with gastrointestinal peristalsis or a small amount of gastric acid reflux into the esophagus. In order to alleviate these uncomfortable symptoms, the burden on the stomach and intestines should be reduced, maintaining small meals, avoiding not eating before bedtime, and eating less stimulating foods. (2) Anemia Pregnant women with multiple pregnancies need to provide nutrition for the growth and development of multiple fetuses, and are more likely to develop iron deficiency anemia and megaloblastic anemia. In addition, the average increase in blood volume of pregnant women with multiple pregnancies is 50%~60%, which is 10% higher than that of single pregnancy, resulting in more obvious plasma dilution, lower hemoglobin and red blood cell pressure volume, and more serious anemia. The incidence of anemia in pregnant women with twin, triple and four or more pregnancies is 40%, 70% and 75% respectively. Anemia in pregnant women may lead to fetal hydrops, intrauterine hypoxia, fetal death, preterm delivery and low birth weight. A study of 8,684 pregnant women in Oxford, England, found that 47% of the pregnant women suffered from iron-deficiency anemia, and in order to compensate for fetal hypoxia, the placenta will undergo adaptive enlargement, resulting in an increase in the weight of the placenta and the ratio of the weight of the placenta to the weight of the fetus, and an increase in the risk of the infant suffering from hypertension in adulthood.J. Once the diagnosis of multiple pregnancies is confirmed, it should be advised to take iron, folic acid, and multivitamins as early as possible, and to increase the intake of proteins. intake. In addition to consuming iron-rich foods, the American College of Obstetricians and Gynecologists recommends 30mg of iron supplementation per day after 12 weeks of gestation. those with severe anemia should be hospitalized, and a small number of transfusions can correct the anemia for a short period of time. (3) Hypertensive disorders in pregnancy Abnormalities in lipid and lipoprotein metabolism exist in patients with hypertensive disorders in pregnancy. Some scholars have proposed that the elevation of triglyceride concentration in pregnant women and the risk of preeclampsia are significantly positively correlated, but there is no information to prove that weight gain restriction in pregnancy can reduce the incidence of hypertensive disorders in pregnancy, and that weight loss in the late stages of pregnancy is detrimental to both mothers and infants, so there is no need for weight restriction in late pregnancy. Weight restriction. In recent years, more and more scholars are paying more attention to the relationship between this disease and the lifestyle and dietary habits during pregnancy, and nutritionists in Etben even use dietary control to treat preeclampsia without using any medication, and just by simply controlling the daily caloric intake of food to about 4,184 to 6,276 kJ, the patient’s blood pressure can be reduced to normal and proteinuria can disappear. Health education should be done in the prenatal clinic, and attention should be paid to guiding pregnant women’s diet, suggesting more intake of foods rich in protein, vitamins, iron, calcium, selenium and other trace elements, and correcting the bad lifestyle and dietary habits, to actively prevent the occurrence of this disease. (4) Fetal growth restriction, preterm delivery and low birth weight According to the data, the average weight of a single birth is 3332g, and the average delivery gestational week is 38.8 weeks, while the average weight of a twin birth is 2347g, and 35.3 weeks; the average weight of a triple birth is 1687g, and 32.2 weeks; the average weight of a quadruple birth is 1309g, and 29.9 weeks; and the average weight of a quintuple birth is reduced to 1105g, and 28.5 weeks. This shows that perinatal weight and gestational week of delivery are negatively correlated with the number of fetuses. Fetal growth restriction (FGR) is a common complication of multiple pregnancies, and most studies have concluded that after mid-gestation, the growth rate of multiparous fetuses decreases due to placental factors. Early detection and treatment of FGR occurring in multiple pregnancies is necessary to guide nutrition, correct anemia, and reduce the incidence of low birth weight babies. It is recommended that the pregnancy weight gain index [BWGI = pregnancy weight gain (kg)/height (m)] be used to reflect the nutritional status of pregnant women, and the results are more objective and comprehensive than simple pregnancy weight gain. At present, it is believed that the weight gain during the whole pregnancy should be controlled between 15.8～20.4kg for twin pregnancy, and the weight gain during pregnancy for triple pregnancy is about 22.7kg. It is appropriate to gain 0.7kg per week in the middle and late stages of pregnancy, which can reduce the chances of preterm delivery and low birth weight babies, and beyond this limit, the weight of the fetus doesn’t increase, but it can lead to postpartum obesity in the mothers. (5) Abnormalities of glucose metabolism in pregnancy Clinically, about 80% of pregnant women with GDM can control their blood glucose in normal range through reasonable diet and exercise, and do not need to use insulin, so the nutritional treatment of GIGT is getting more and more attention from clinics. However, there is a lack of unified and standardized program on nutritional therapy for patients with abnormal glucose metabolism in pregnancy at home and abroad, and many hospitals in China are limited to principle guidance. The American Diabetes Association suggests providing individualized medical nutritional therapy for patients with GDM and impaired glucose tolerance in pregnancy as much as possible. It also formulates dietary prescriptions, closely monitors changes in fasting and 2h postprandial blood glucose, and promptly adjusts dietary content so that blood glucose is controlled at normal or near-normal levels. It is also necessary to maintain good dietary habits all the time after delivery, control body weight, and restore normal blood glucose levels as soon as possible to avoid or delay the onset of type 2 diabetes mellitus. Mothers with gestational diabetes are advised to breastfeed as much as possible, which can reduce the risk of type 2 diabetes in infants and delay the age of onset of the disease and reduce the extent of its onset.