New research shows that mothers who give birth to twins are twice as likely to be hospitalized for heart disease in the first year after delivery compared to mothers who have just one baby.
The risk is even higher for twin mothers who had high blood pressure during pregnancy.
This study, published in the European Heart Journal, was led by Professor Cande Ananth from Rutgers Robert Wood Johnson Medical School in the United States.
He explained that twin pregnancies have become more common in recent years due to fertility treatments and older maternal age.
While past studies suggested there was no long-term increase in heart disease risk for mothers of twins, this finding did not match what doctors often see in hospitals. This prompted researchers to take a closer look at the short-term risks.
To investigate, the researchers analyzed data from 36 million hospital deliveries in the U.S. between 2010 and 2020.
They focused on four groups of mothers: those who had twins with normal blood pressure, those who had twins and developed high blood pressure disorders, those who had one baby with normal blood pressure, and those who had one baby and high blood pressure during pregnancy.
High blood pressure conditions during pregnancy, also known as hypertensive disorders, include gestational hypertension (high blood pressure that develops during pregnancy), pre-eclampsia (high blood pressure with signs of organ damage), eclampsia (seizures due to pre-eclampsia), and superimposed pre-eclampsia (worsening high blood pressure in women who already had hypertension before pregnancy).
The researchers found that twin pregnancies were linked to a higher risk of heart problems after birth. Within a year of delivery, 1,105 out of every 100,000 mothers of twins were readmitted to the hospital for heart-related issues, compared to 734 per 100,000 among mothers of singletons.
When compared to mothers of singletons with normal blood pressure, mothers of twins with normal blood pressure were twice as likely to be hospitalized for heart problems. The risk was even greater for mothers of twins who had high blood pressure during pregnancy—they were more than eight times as likely to be admitted for heart disease.
Interestingly, the study found that after the first year, mothers of twins with high blood pressure conditions had lower overall death rates than mothers of singletons with high blood pressure. This suggests that twin mothers face a higher short-term risk, while mothers of singletons with high blood pressure may have other long-term health risks.
However, the study had some limitations. The researchers could not analyze important risk factors for heart disease, such as race, smoking, obesity, and drug use, because this information was not consistently recorded in the hospital data.
Dr. Ruby Lin, the study’s lead author, emphasized that carrying twins puts extra strain on the heart, and it takes time for the body to recover after pregnancy. She warned that even if a twin pregnancy seems healthy, mothers should be aware of the increased risk of heart disease in the first year after delivery.
She also pointed out that women undergoing fertility treatments—especially those who are older, overweight, or have diabetes, high blood pressure, or existing heart disease—should be informed about these risks.
Experts say that doctors, health insurance providers, and healthcare systems should ensure that mothers of twins receive medical follow-ups for at least a year after giving birth.
In an editorial that accompanied the study, Dr. Katherine Economy from Brigham and Women’s Hospital in Boston highlighted the importance of understanding heart disease risks in twin pregnancies.
She pointed out that one-third of pregnancy-related deaths in the U.S. are due to heart problems. Twin pregnancies account for about 3% of all births, and one-third of them result from fertility treatments.
Dr. Economy also emphasized that the period after childbirth, sometimes called the “fourth trimester,” is a critical time for preventing long-term heart problems.
She stressed that doctors from different fields—such as obstetrics and cardiology—should work together to improve post-pregnancy care for mothers, especially those who had twin pregnancies or high blood pressure.
Analysis of Findings
This study provides strong evidence that twin pregnancies put extra stress on a mother’s heart, particularly in the first year after birth.
The findings suggest that even in cases where blood pressure remains normal during pregnancy, mothers of twins still face higher heart disease risks than those who have one baby. The danger is even greater for twin pregnancies complicated by high blood pressure.
While the study’s strength lies in its large-scale data analysis, it also has limitations. Because it relied on hospital records, it could not account for personal health factors like lifestyle choices, genetics, or medical history. More research is needed to understand how these factors interact with twin pregnancies.
The results highlight the importance of follow-up care for new mothers, particularly those who gave birth to twins. Women should be aware of their heart health in the months following delivery and should seek medical advice if they experience symptoms such as chest pain, shortness of breath, or unusual fatigue.
This study also raises questions about fertility treatments, which have contributed to the rising number of twin pregnancies.
Women who are considering or undergoing fertility treatments should discuss the potential heart-related risks with their doctors, especially if they already have risk factors like high blood pressure or obesity.
Overall, this research underlines the need for better postpartum care. Health providers should monitor mothers—especially those with twin pregnancies or pregnancy-related high blood pressure—closely after birth to prevent serious complications.
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The research findings can be found in European Heart Journal.
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