Women who give birth to twins face double the risk of being hospitalized for heart disease within a year. Their risk is compared to women who have singletons. The risk increases significantly for mothers with high blood pressure during pregnancy. This detail is noted in a study published in the European Heart Journal.
The research was led by Professor Cande Ananth of Rutgers Robert Wood Johnson Medical School. It analyzed data from 36 million hospital deliveries across the U.S. from 2010 to 2020. The findings reveal a significant short-term cardiovascular risk for mothers of twins, challenging previous studies that suggested no long-term impact.
“The rate of twin pregnancies has risen due to fertility treatments and older maternal ages,” said Professor Ananth. “We wanted to investigate if twin pregnancies increase cardiovascular risks. This concern arose from the high rate of maternal mortality linked to heart disease in the first year postpartum.”
ALARMING TRENDS
Researchers divided pregnant patients into four groups:
- Twin pregnancies with normal blood pressure
- Twin pregnancies with hypertensive disorders (high blood pressure conditions)
- Singleton pregnancies with normal blood pressure
- Singleton pregnancies with hypertensive disorders
They examined hospital readmissions for heart conditions, including heart attacks, heart failure, and strokes, within a year of childbirth.
The study found that 1,105.4 mothers per 100,000 twin deliveries were readmitted for cardiovascular issues compared to 734.1 per 100,000 for singleton births.
HEART DISEASE RISK EIGHT TIMES HIGHER FOR SOME MOTHERS
Mothers of twins with normal blood pressure were twice as likely to be hospitalized for heart disease. This is compared to singleton pregnancies with normal blood pressure. Those with twins and high blood pressure faced an eightfold increase in risk.
“The maternal heart works harder during twin pregnancies, and it takes weeks to return to its pre-pregnancy state,” said Dr. Ruby Lin, the study’s lead author. “Even in cases without complications, twin pregnancies significantly elevate short-term heart disease risks.”
HYPERTENSION IN PREGNANCY ADDS TO HEART RISKS
Hypertensive disorders of pregnancy, including gestational hypertension, pre-eclampsia, and eclampsia, further raise the likelihood of cardiovascular complications. Mothers with high blood pressure during a singleton pregnancy faced a higher risk of death from any cause in the first year. This risk was higher than that for mothers of twins with high blood pressure.
This suggests that pre-existing cardiovascular risk factors may play a role in heart-related deaths among mothers with singleton pregnancies.
MISSING DATA ON KEY RISK FACTORS
Despite the strong association between twin pregnancies and cardiovascular disease, researchers faced limitations. Essential risk factors such as race, smoking, obesity, and drug use were not consistently recorded in the database. These factors could further influence the risk of heart disease postpartum.
FERTILITY TREATMENTS AND HEART DISEASE RISK
With an increasing number of pregnancies resulting from fertility treatments, researchers emphasize the importance of heart health monitoring.
“Patients undergoing fertility treatments should be counseled about the added risks of twin pregnancies,” Dr. Lin noted. This is especially important for those with pre-existing cardiovascular risk factors like obesity, diabetes, or hypertension.
Dr. Katherine Economy of Brigham and Women’s Hospital, who co-authored an editorial accompanying the study, stressed the need for improved postpartum care.
“One-third of pregnancy-related deaths are linked to cardiovascular disease,” Dr. Economy stated. “We must embrace the fourth trimester—the first 12 weeks after birth—as a critical window for intervention.”
She highlighted the importance of collaboration between obstetricians, cardiologists, and other medical specialists to enhance postpartum care and reduce maternal mortality.
CALL FOR ACTION: ONGOING MONITORING AND PREVENTIVE CARE
The study underscores the urgent need for:
- Regular cardiovascular screening for mothers of twins, especially those with high blood pressure during pregnancy.
- Extended postpartum care beyond the standard six-week checkup, particularly for high-risk pregnancies.
- Public health initiatives to raise awareness about heart disease risks following twin pregnancies.
- Insurance coverage for postpartum heart health monitoring to prevent complications.
“Given these higher risks, healthcare providers and insurance companies should support long-term follow-ups for mothers of twins,” Dr. Lin emphasized.
The findings provide a clear message: twin pregnancies come with significant short-term cardiovascular risks. Healthcare systems must prioritize postpartum heart disease prevention. They should ensure that mothers—especially those with high-risk pregnancies—receive adequate follow-up care in the crucial first year after childbirth.
With increased awareness and proactive medical intervention, the long-term health of mothers with twin pregnancies can be safeguarded, reducing the risk of life-threatening heart conditions in the postpartum period.