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Updated: Nov 19, 2025

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Cardiovascular function during triplet pregnancy.

Victoria L Meah1, Rshmi Khurana2,3, Lisa K Hornberger4

  • 1Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.

Journal of Applied Physiology (Bethesda, Md. : 1985)
|January 28, 2021
PubMed
Summary

Healthy triplet pregnancies show reduced cardiovascular function, with lower cardiac mechanics and higher blood pressure variability compared to singleton and twin pregnancies. This may increase risks associated with multifetal pregnancies.

Keywords:
cardioautonomic regulationcold pressor testleft ventricular functionmultifetal

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Area of Science:

  • Cardiovascular Physiology
  • Maternal-Fetal Medicine
  • Autonomic Nervous System Regulation

Background:

  • Pregnancy places significant stress on the maternal cardiovascular system.
  • Cardiovascular adaptations are amplified in twin pregnancies but less understood in triplet pregnancies.
  • Multifetal pregnancies are associated with increased maternal complication risks.

Purpose of the Study:

  • To compare maternal cardiac function, cardioautonomic regulation, and blood pressure reactivity in singleton, twin, and triplet pregnancies.
  • To investigate potential cardiovascular compromises in healthy triplet pregnancies.

Main Methods:

  • Case series comparing two triplet, three twin, and three singleton pregnancies.
  • Echocardiography for cardiac structure and function.
  • Photoplethysmography for blood pressure variability (BPV) and electrocardiogram for heart rate variability (HRV).
  • Cold pressor test to assess blood pressure reactivity.

Main Results:

  • Triplet pregnancies exhibited greater resting cardiac output but reduced cardiac deformation (strain, torsion) compared to singleton and twin pregnancies.
  • Individuals with triplet pregnancies showed sympathetic dominance, indicated by lower HRV and higher BPV.
  • Elevated blood pressure reactivity was observed in triplet pregnancies during the cold pressor test.

Conclusions:

  • Healthy triplet pregnancies may be associated with reduced maternal cardiovascular function.
  • Compromised cardiac mechanics and heightened sympathetic activity in triplet pregnancies could contribute to increased risks.
  • Further research is needed to understand the long-term implications for maternal health in multifetal pregnancies.