According to recent research published in the European Heart Journal, mothers who give birth to twins are considerably more likely to be hospitalised for heart disease the year after delivery than mothers who have singleton pregnancies. The study, conducted by Professor Cande Ananth of Rutgers Robert Wood Johnson Medical School in New Jersey, USA, found that the risk is even higher for twin mothers who had high blood pressure during pregnancy.

Mothers of Twins face higher heart disease risks postpartum, especially with pregnancy-related hypertension, emphasizing the need for personalized care and improved maternal health vigilance

The study, which examined data from 36 million hospital deliveries in the United States between 2010 and 2020, discovered that moms with twins were twice as likely to be hospitalised for cardiovascular disease (CVD) within a year of childbirth as those with singletons. For women with twins who also had hypertensive problems during pregnancy, the risk increased to more than eight times that of singleton pregnancies with normal blood pressure.

"The rate of twin pregnancies worldwide has risen in recent decades, driven by fertility treatments and older maternal ages," Prof. Ananth added. "Given the unacceptably high rate of maternal mortality in the first year after birth due to cardiovascular disease, we wanted to examine whether twin pregnancies increase this risk."

The study classified pregnant patients into four groups: twins with normal blood pressure, twins with hypertensive disorders, singleton pregnancies with normal blood pressure, and singleton pregnancies with hypertensive disorders. Pregnancy hypertensive disorders include gestational hypertension, pre-eclampsia, eclampsia, and superimposed pre-eclampsia.

The researchers discovered that mothers of twins had a much greater proportion of hospital readmissions for cardiovascular illness within a year of childbirth (1,105.4 per 100,000 deliveries) than singleton pregnancies (734.1 per 100,000 deliveries). Notably, moms of twins who had high blood pressure during pregnancy were at the highest risk, with CVD hospitalisation rates increasing by eightfold.

However, the study also found an unexpected long-term trend: one year after birth, mortality from any cause, including heart disease, was greater among moms with singleton pregnancies and high blood pressure than those with twin pregnancies and high blood pressure. This shows that, while the immediate danger is higher for twin moms, additional pre-existing cardiovascular risk factors in single mothers may have an impact on the long-term risk.

The study's primary author, Dr. Ruby Lin, a maternal-foetal medicine fellow at Rutgers, emphasised the need for knowledge of the distinct cardiovascular demands of twin pregnancies.

"The maternal heart works harder for twin pregnancies than for singleton pregnancies, and it takes weeks for the maternal heart to return to its pre-pregnancy state,"Dr. Lin explained.

Dr. Lin also emphasised the importance of raising awareness and providing follow-up care for twin moms, especially those pursuing reproductive procedures. "People with twin pregnancies should be aware of the short-term increase in cardiovascular disease complications in the first year after birth, even if they had a pregnancy that was not complicated by high blood pressure conditions," according to her.

In an accompanying editorial, Dr. Katherine Economy of Brigham and Women's Hospital in Boston and her colleagues stressed the need to reduce maternal mortality and enhance postpartum care. "We must embrace the fourth trimester (12 weeks after delivery) as a critical time period to make impactful changes that will influence long-term cardiovascular health," they stated in their letter.

The editorial also advocated for increased coordination between obstetricians, cardiologists, and other medical professionals to prevent postpartum problems and enhance access to excellent care. "Collaboration is essential to address the crisis of maternal mortality and to reduce postpartum complications," the researchers said.

The study had some good points, but the researchers also said it had some problems. For example, they couldn't look at important risk factors for heart disease like race or ethnicity, smoking, obesity, and drug use because the database wasn't entered evenly. Future research is needed to investigate these characteristics and their effects on maternal health outcomes.

The findings emphasise the importance of increased vigilance and personalised care for twin mothers, especially in the first year following birth. As twin pregnancies increase globally due to fertility treatments and older maternal ages, healthcare practitioners and policymakers must prioritise postpartum care to reduce the risk of cardiovascular disease and enhance mothers' long-term health outcomes.