Twin pregnancies increase CVD risk in mothers in first year postpartum, finds study

By Melanie Hinze

Research published in the European Heart Journal reports that twin pregnancies are associated with increased risks for cardiovascular disease (CVD) in mothers in the first year postpartum, compared with singleton pregnancies.

Researchers used the Nationwide Readmissions Database of US Hospitals from 2010 to 2020 to determine rates of readmission for CVD in four groups – mothers who had twin deliveries with and without hypertensive disease of pregnancy (HDP), and those who had singleton deliveries with and without HDP.

Of 36 million delivery hospitalisations, the rates of CVD readmission were 1105.4 per 100,000 for mothers of twin pregnancies (1.1%) and 734.1 per 100,000 for those with singleton pregnancies (0.7%).

For patients who had twin pregnancies with HDP, there was an eightfold increase in CVD complications in the first year postpartum, and for those without hypertensive disease, there was a twofold increase compared with mothers of singletons without HDP.

Mothers who had twin pregnancies with HDP had a 32 times increased risk of hypertensive heart disease, 18 times increased risk of heart failure and 12 times increased risk of cardiomyopathy in the first year compared with mothers of singletons without HDP.

Even among mothers who had twins without HDP there was a threefold increased risk of cardiomyopathy in the first year postpartum, compared with singleton pregnancies without HDP.

Professor Amanda Henry, Program Head, Women’s Health, The George Institute for Global Health, and Professor of Obstetrics, UNSW Medicine and Health, Sydney, told Medicine Today that this study confirmed that HDP was associated with increased CVD, including in the first year after birth.

‘These risks are present after both singleton and twin pregnancies, [and] potentially further increased after twins,’ she said.

‘This reinforces the importance of postpartum follow up and management after HDP for all mothers,’ she added.

Professor Henry said the NHMRC-endorsed 2023 SOMANZ Hypertension in Pregnancy Guidelines (https://somanz.org/hypertension-in-pregnancy-guideline-2023/) were an excellent resource, and included a chapter on postpartum care with a checklist for clinicians (https://www.somanz.org/content/uploads/2024/01/8.1-Clinician-check-list-for-long-term-post-partum-care.pdf).

‘Although the results of this research by themselves do not warrant a change in postpartum care after having twins, it is important to be aware that a woman’s physical, mental and social health may all be more affected after twin pregnancy,’ said Professor Henry.

She told Medicine Today that the six-week postpartum check was therefore a particularly important check up that should include reviewing pregnancy and general health history and checking blood pressure.

Eur Heart J 2025; 00, 1–10; https://doi.org/10.1093/eurheartj/ehaf003.