Twin Pregnancies Pose Elevated Risk of Post-Partum Cardiovascular Complications, suggests study

A new study revealed that twin pregnancies, even without hypertensive disorders of pregnancy (HDP), significantly increase the risk of cardiovascular complications when compared to singleton pregnancies. The findings published in the European Heart Journal found heightened cardiovascular strain associated with carrying twins.

The research analyzed data from the Nationwide Readmissions Database of U.S. hospitals from 2010 to 2020. This study compared the rates of cardiovascular disease (CVD)-related hospitalizations and mortality within a year after delivery among 4 groups as twin pregnancies with and without HDP, and singleton pregnancies with and without HDP. Cox proportional hazard regression models were used to evaluate the risks, with singleton pregnancies without HDP serving as the reference group.

Of 36 million delivery hospitalizations analyzed, twin pregnancies were associated with significantly higher rates of CVD readmissions when compared to singleton pregnancies. Twin deliveries had a readmission rate of 1,105.4 per 100,000 delivery admissions, when compared to 734.1 per 100,000 for singletons.

The adjusted hazard ratios (HRs) further highlighted that twin pregnancies with HDP had the highest risk, with an HR of 8.21 (95% confidence interval [CI] 7.48–9.01), which indicated over 8-times the risk compared to singletons without HDP. Singleton pregnancies with HDP followed closely with an HR of 5.89 (95% CI 5.70–6.08). Even twins without HDP showed a notable risk increase, with an HR of 1.95 (95% CI 1.75–2.17).

These results suggest that twin pregnancies place considerable stress on the maternal cardiovascular system, increasing post-partum complications even in the absence of hypertensive disorders. The study emphasizes the need for elevated post-partum surveillance and cardiovascular care for women carrying twins. The findings advocate for improved pre-conception counselling for individuals with cardiovascular risk factors, particularly those undergoing infertility treatments, which can increase the likelihood of twin pregnancies.

Clinicians are urged to prioritize comprehensive cardiovascular monitoring and care for these mothers during the critical post-partum period. As the demand on the maternal cardiovascular system in twin pregnancies is higher than previously thought, these outcomes highlight a critical need for targeted healthcare interventions to safeguard maternal health.

Reference:

Lin, R., Fields, J. C., Lee, R., Rosenfeld, E. B., Daggett, E. E., Sharma, R., & Ananth, C. V. (2025). Hospitalization for cardiovascular disease in the year after delivery of twin pregnancies. European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf003