Systematic Management of Twin Pregnancies to Reduce Pregnancy Complications

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Systematic Management of Twin Pregnancies to Reduce Pregnancy Complications

Twin pregnancies have grown more common in recent decades, largely due to advances in assisted reproductive technologies (ART). While welcoming two babies is a joy, twin pregnancies carry higher risks of complications like preterm birth, gestational diabetes (GDM), and preeclampsia—especially for women who are obese or overweight. A 2020 study from Shanghai’s International Peace Maternity and Child Health Hospital explores whether structured care—including diet, exercise, and weight control—can lower these risks for twin parents.

The Study Design

Researchers analyzed data from 1,994 women with twin pregnancies who delivered at the hospital between 2013 and 2017. They split participants into two groups:

  • Control group: 710 women who delivered in 2013–2014, before the hospital launched its systematic management program.
  • Intervention group: 1,284 women who received tailored support from 2015–2017. This included guidance on diet, physical activity, weight control (following 2009 Institute of Medicine guidelines), sleep, and mental health.

Only women who delivered after 26 weeks (and excluded those with stillbirths or fetal reductions for anomalies) were included. The team used standard statistical tests to compare complication rates between groups.

Key Results: What Worked?

The intervention led to significant improvements for high-risk groups and common complications:

  1. Preterm birth in obese/overweight women: For women with a pre-pregnancy body mass index (BMI) of 25+ kg/m² (overweight/obese), preterm birth rates plummeted from 73.6% (control) to 48.5% (intervention). Women in the control group were nearly 3 times more likely to have a preterm birth.
  2. Less hyperthyroidism: The control group had a 3.8% rate of hyperthyroidism (overactive thyroid), compared to 2.3% in the intervention group. Control group women were 1.7 times more likely to develop the condition.
  3. Reduced anemia: Anemia (low iron levels) dropped from 22.5% to 17.8%. Control group women were 1.3 times more likely to be anemic.
  4. Lower postpartum hemorrhage: The risk of heavy bleeding after birth fell from 6.9% to 4.6%. Control group women were 1.5 times more likely to experience hemorrhage.

While rates of GDM, gestational hypertension, and insulin use for GDM decreased slightly in the intervention group, these changes weren’t statistically significant—meaning more research is needed to confirm those trends.

Why Systematic Care Helps Twins

The study’s approach is grounded in twin pregnancies’ unique biology:

  • GDM risk: Pregnancy makes women more insulin-resistant (a GDM driver), and twins have larger placentas that produce more “diabetogenic” hormones—so GDM is more common.
  • Obesity risks: Obese/overweight women are more likely to develop severe obesity during pregnancy, which raises maternal and fetal mortality.
  • Exercise benefits: Many twin parents avoid physical activity, but staying active boosts heart health and keeps uterine muscles strong—key for preventing preterm birth and hemorrhage.

As previous research notes, regular exercise reduces GDM risk and improves glucose metabolism. This study builds on that by showing exercise is safe (and beneficial) for twin pregnancies.

What This Means for Twin Parents

The results highlight that targeted support works—especially for women at highest risk (like those with obesity). While overall preterm birth rates dropped slightly (63.1% to 59.7%), the impact was life-changing for obese/overweight women, who are already more likely to deliver early. And importantly, exercise didn’t increase preterm birth risk—in fact, it may lower postpartum hemorrhage.

The team notes that more research is needed on “complex” twins (like monochorionic twins, who share a placenta). But for now, the takeaway is clear: structured, holistic care can help twin parents navigate their high-risk pregnancy more safely.

Study Credentials

This research was conducted by a team from the Department of Obstetrics and Gynecology at Shanghai Jiao Tong University’s International Peace Maternity and Child Health Hospital—one of Shanghai’s largest labor centers. It was approved by the hospital’s ethics committee (No. GKLW 2015-62), and all participants provided written informed consent.

The study was published in the Chinese Medical Journal in 2020.

doi.org/10.1097/CM9.0000000000000808

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