Your Heart Health After a Complicated Twin Pregnancy

I know how easy it is to disappear from your own medical story.

My identical twin sons, Peter and Maurice, developed Stage 3 twin-to-twin transfusion syndrome (TTTS) during my pregnancy.

I was a physician assistant. I had spent years working in medicine. And still, when my own pregnancy became complicated, I was a mother trying to understand what was happening to my babies and what we needed to do next.

I underwent laser surgery during pregnancy in Miami. Ten days later, my sons were delivered by emergency C-section at 28 weeks and 5 days. Then came the neonatal intensive care unit (NICU).

For months, almost every number I knew belonged to them.

Their weights. Their oxygen. Their feeds. Their scans. Their milestones. The number of days until each of them could finally come home.

That is what happens when your babies are sick. Your attention goes where it has to go.

But something had happened to my body too.

My pregnancy was part of my medical history, not only my sons’ medical history.

Years later, as I began looking more deeply at women’s heart health, I kept coming back to that distinction.

They are not the same story. TTTS, TAPS or selective growth restriction does not mean a mother has heart disease. But carrying twins and some pregnancy complications affecting the mother can be important to a mother’s heart care.

That is why I made this resource. Not to give another mother one more thing to worry about. To help her carry her own story forward too.

Does carrying twins affect a mother’s heart?

Carrying twins can increase the risk of certain heart problems during pregnancy and after delivery. Multiple pregnancy is a recognized risk factor for peripartum cardiomyopathy, an uncommon type of heart failure in which the heart muscle becomes weak late in pregnancy or in the months after birth.

Research has also found more hospital stays for heart or blood-vessel problems during the first year after a twin birth than after the birth of one baby. That does not mean most twin mothers will develop heart failure, or that carrying twins automatically predicts heart disease decades later. Timing, complications affecting the mother and her health now all matter.

Identical twins. Different sizes.

Identical twins can be very different sizes. Maurice was the smaller twin and had selective growth restriction.

Peter and Maurice are identical twins. But during pregnancy, they were not growing equally.

Maurice had selective intrauterine growth restriction (sIUGR), now also commonly called selective fetal growth restriction (sFGR). In twins who share a placenta, one baby can receive a smaller share of that placenta. That can limit growth.

sIUGR is not another name for TTTS. They are different conditions, although they can occur in the same pregnancy.

In TTTS, the donor twin sends more blood to the other baby than comes back. The baby receiving that extra blood is called the recipient twin.

In our pregnancy, Maurice was the donor twin and the twin affected by selective growth restriction.

Maurice weighed less than two pounds.

Maurice’s NICU note records a birth weight of 790 grams — about 1 pound 12 ounces — and a birth length of 32.3 centimeters — about 12.7 inches. These are his birth measurements, not the later measurements also written on the note.

Those numbers mattered enormously to his care. But they also raise a question mothers may never be told to ask: does a baby’s growth restriction tell us anything about the mother’s health?

Having a baby who did not grow as expected can be an important part of a mother’s pregnancy history. Research from pregnancies with one baby cannot automatically tell us what selective growth restriction in twins means for the mother’s future heart health.

So we record it. We do not turn it into a diagnosis for the mother. And we ask.

“One of my twins had selective growth restriction. Does the reason for that growth restriction, together with my own pregnancy history, change anything about my heart-health care?”

TTTS, TAPS and sIUGR: what do they mean for Mom?

TTTS and TAPS are not diagnoses of heart disease in the mother. Neither has been shown, on its own, to predict a mother’s heart disease later in life.

What happened to your babies? What happened to you?

Both belong in your pregnancy story. Keep them separate so your clinician can see the whole picture without confusing a condition affecting a baby with one affecting the mother.

Put your pregnancy history in one place.

The appointment sheet helps you record what happened during the pregnancy, what happened to you, what you know about your health now, and what you want to ask.

No email or registration required. This is an appointment-preparation tool, not a risk calculator or diagnosis.

Five questions to take to your clinician

1. Does anything that happened during my pregnancy change what you recommend for my heart health now?
2. Is my blood pressure where you want it to be?
3. Should we review my cholesterol, blood sugar or previous results?
4. Is there anything from my pregnancy history we should follow over time?
5. When should we check again?

If you do not know what to ask, start with #1.

If your pregnancy was years ago

Bring it up anyway. You can say: “I realized I’ve never really told you what happened during my twin pregnancy. Could any of it matter to my heart health now?”

If you are living with loss

This resource is for you too. Your pregnancy remains part of your medical history whether you brought home two babies, one baby or neither. You do not have to repeatedly tell the most painful parts of your story to receive care for yourself. Share what you are comfortable sharing and ask for the relevant medical history to be recorded.

Connection changed our story.

Connection has always been at the center of what I do because connecting with other mothers ultimately helped save my sons.

When our pregnancy became frightening, my search led me to Mary Slaman, founder of the Twin to Twin Transfusion Syndrome Foundation, and to a community of mothers who understood a diagnosis I was only beginning to understand myself.

Then, on Palm Sunday night, a mother I had never met sent me a message through the parent community on Facebook. She gave me Dr. Ruben Quintero’s phone number and told me to call.

I called. He answered.

That connection led us to The Fetal Institute in Miami, where my sons were evaluated and treated. I underwent laser surgery during pregnancy for Stage 3 TTTS. I remember Dr. Quintero explaining afterward that he had encountered very large blood-vessel connections and had used a highly selective approach to manage the circulation between my donor and recipient twins. The exact operative terminology belongs in the medical record; this is how I remember his explanation as their mother.

That mother did not diagnose me. She listened to my story, recognized something in it and shared what she knew. Another parent’s experience should never replace medical advice. But another mother’s story helped me find the medical care we needed.

Years later, I realized there was another connection I had missed. I knew my sons’ medical history by heart. But that pregnancy was part of my medical history too.

That is part of why I built HEART RESERVE: to help women connect the important pieces of their own health story and know what to ask next.

Trusted resources

Evidence behind this resource

American Heart Association: Peripartum Cardiomyopathy

Heart and blood-vessel hospital readmission after twin pregnancy

Longer-term heart and blood-vessel disease after twin pregnancy and high blood pressure in pregnancy

American Heart Association: Pregnancy complications and later heart and blood-vessel risk

Society for Maternal-Fetal Medicine: TTTS and TAPS guidance

CDC: Urgent Maternal Warning Signs

Definitions: NICHD: Preeclampsia; NIDDK: Gestational diabetes; Johns Hopkins Medicine: Donor and recipient twins; Clinical study: Mirror syndrome.

This resource provides general education and appointment preparation. It does not diagnose disease, calculate individual risk or replace medical care. Review status: This resource has not yet undergone independent clinical review.