Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehaf003. https://doi.org/10.1093/eurheartj/ehaf003 Dr. Ruby Lin et al. European Heart Journal, ehaf064. https://doi.org/10.1093/eurheartj/ehaf064 Dr. Alexandria F. Williams et al.
Points
- Twin pregnancies had a higher cardiovascular disease (CVD) readmission rate (1,105.4 per 100,000) compared to singleton pregnancies (734.1 per 100,000).
- Twin pregnancies with HDP had the highest risk, with an adjusted hazard ratio (HR) of 8.21 for CVD readmission compared to singleton pregnancies without HDP.
- Singleton pregnancies with HDP had a higher risk of mortality than twin pregnancies with HDP, though CVD readmission rates were still higher in twin pregnancies without HDP (HR 1.95).
- Twin pregnancies place significant strain on the maternal cardiovascular system, even in the absence of hypertensive complications.
- The study highlights the need for enhanced postpartum surveillance and follow-up care for twin pregnancies, particularly for those conceived through fertility treatments.
Summary
This study examines the impact of twin pregnancies on cardiovascular disease (CVD) hospitalizations and mortality in the first year postpartum, particularly comparing twin pregnancies with and without hypertensive disease of pregnancy (HDP) to singleton pregnancies. Data was gathered from the Nationwide Readmissions Database, including 36 million delivery hospitalizations in the U.S. from 2010 to 2020. Researchers found that CVD readmission rates were significantly higher for twin pregnancies than singletons, with twin pregnancies having a readmission rate of 1,105.4 per 100,000 deliveries, compared to 734.1 for singleton pregnancies. Additionally, twin pregnancies with HDP showed the highest risk, with an adjusted hazard ratio (HR) for CVD readmission of 8.21 (95% CI 7.48–9.01) compared to singleton pregnancies without HDP.
The results also revealed differences in mortality risks. The risk of all-cause and CVD-related mortality in the first year postpartum was higher among singleton pregnancies with HDP compared to twin pregnancies with HDP. While the CVD readmission rate for twin pregnancies without HDP was lower (HR 1.95, 95% CI 1.75–2.17), singleton pregnancies with HDP had a higher risk of mortality, indicating that the increased risk in twin pregnancies may be more acute in the first year but not persist long-term. These findings suggest that the maternal cardiovascular system faces significant strain during twin pregnancies, even in the absence of hypertensive complications.
The study underscores the need for heightened postpartum surveillance and follow-up care for women with twin pregnancies, especially those undergoing fertility treatments. Healthcare providers should be aware of the short-term increased risk for cardiovascular complications following twin pregnancies, even without HDP, and take preventive measures. The findings advocate for comprehensive post-partum care, collaboration among specialists, and consideration of maternal cardiovascular health to improve long-term outcomes.
Links to the articles:
- https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehaf003/7989629
- https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf064/7994443
References 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, ehaf003. https://doi.org/10.1093/eurheartj/ehaf003 Williams, A. F., Valente, A. M., & Economy, K. E. (2025). Double double, future trouble? Opportunities for cardio-obstetric collaboration to reduce future cardiovascular events following twin pregnancies. European Heart Journal, ehaf064. https://doi.org/10.1093/eurheartj/ehaf064
