Singer Jesy Nelson recently shared an emotional update regarding the complications she is experiencing in her pregnancy with twin babies. Former Little Mix singer Jesy, who is having twins with partner Zion Foster, announced that she has been diagnosed with pre-twin-to-twin transfusion syndrome (pre-TTTS). The condition, which is present in pregnancies involving twins with a shared placenta, has serious risks involved and needs intense medical supervision. As Nelson embarks on this difficult journey, her story enlightens us about a rare but dangerous condition many expectant parents may not know much about.

Twin-to-twin transfusion syndrome is a rare but dangerous condition that arises in monochorionic twin pregnancies, in which identical twins share a single placenta. The placenta supplies the developing babies with oxygen, nutrients, and blood flow, but in TTTS, there is an imbalance of blood vessels that interconnect the twins, and thus the vital resources are not evenly distributed. One twin, or the donor twin, shares excess blood with the other, referred to as the recipient twin. This leads to one baby becoming malnourished and possibly anemic, and the other in danger of heart problems due to too much blood.

Nelson described her diagnosis in a heartfelt Instagram video, explaining that she is currently in the pre-stage of TTTS and undergoing frequent monitoring. "I am being scanned twice a week, and each time, things have gotten a little worse," she shared, expressing her fears and hopes for the health of her babies.

Potential Risks of TTTS

If left untreated, TTTS can have devastating consequences. Medical research indicates that:

• 90% of the cases of untreated TTTS lead to loss of one or both twins.
• Despite treatment, only a 70% survival rate for both twins is assured.
• Severe forms can result in preterm labor, cardiac failure in the recipient twin, and organ failure in the donor twin.
• Complications in long-term survivors include neurological damage and developmental delay in surviving infants.

TTTS usually advances in stages, beginning with minimal changes in fluid levels and worsening as one twin continues to get an unequal share of blood. In extreme cases, fetal laser surgery, referred to as the Solomon technique, can be employed to divide the blood vessels and balance the twins.

Why Identical Twin Pregnancies Are More Complicated

Identical twins may develop differently, and their own unique form of placental sharing can have a dramatic effect on pregnancy risk. Jesy Nelson's twins are considered monochorionic diamniotic (mono/di), which means they share a placenta but have two amniotic sacs. This is the type of pregnancy in about 70% of identical twin pregnancies and carries an increased risk of complications like TTTS, umbilical cord entanglement, and growth restriction.

Conversely, dichorionic diamniotic (di/di) twins both have a separate placenta and amniotic sac, which greatly diminishes the threat of TTTS. Twin pregnancy type is normally identified by early ultrasound, with physicians being able to track future complications from inception.

Other Twin Pregnancy Health Risks

Twin pregnancies, even without the presence of TTTS, entail a variety of health risks to the mother as well as infants:

1. Premature Birth

Over 60% of twin pregnancies end in premature delivery, with birth usually taking place before 37 weeks. Premature infants can have immature organs and need neonatal intensive care (NICU) assistance to assist with breathing, feeding, and infection fighting.

2. Gestational Hypertension and Preeclampsia

Pregnant women with multiples are at increased risk of having high blood pressure during pregnancy. This, if left untreated, can result in preeclampsia, a serious complication of pregnancy that can result in damage to organs, preterm labor, and in some cases, maternal or fetal death.

3. Anemia

Pregnant women carrying multiples are twice as likely to experience anemia, a condition where the body does not produce enough healthy red blood cells. This can lead to fatigue, dizziness, and complications during delivery.

4. Birth Defects

According to John Hopkins Medicine, multiple birth babies are twice as likely to have congenital abnormalities compared to single births. These can include heart defects, neural tube defects, and gastrointestinal issues.

5. Amniotic Fluid Imbalances

When twins have to share a placenta, they are more likely to have polyhydramnios (excess amniotic fluid) or oligohydramnios (not enough amniotic fluid). Both result in distress to the babies during fetal development and can result in premature labor.

6. Postpartum Hemorrhage

Twins are at increased risk of excessive postpartum hemorrhage because their uterus is larger and there are greater blood supply needs.

Jesy Nelson's openness about her challenging experience is raising awareness for TTTS, a condition that few individuals—let alone expectant mothers and fathers—might be aware of. Through her tearful video, Nelson stressed the significance of knowing about twin pregnancies aside from the thrill of having multiples. "We had no idea that this type of thing occurs when you're having twins. We just desperately want to make people aware of this because there are so many people who aren't aware."

Her case reminds us of the intricacies involved in twin pregnancy and the significance of early identification and medical management. For mothers carrying twins, frequent ultrasounds and vigilance can become a life-and-death issue for early detection and better outcomes of both babies.

Through constant medical attention and care, she and her partner Zion Foster remain positive and get ready for their babies to be born. In other parents whose situations are no different, the story of Nelson highlights awareness, medical progress, and emotional encouragement in handling complicated pregnancies.

The expecting parents of twin siblings are advised to discuss TTTS screening and possible interventions with their physicians to give their babies the best chance.

Kerala's decision to switch from an expensive branded medicine for children with spinal muscular atrophy (SMA) with a much cheaper Indian-made alternative has sparked a dispute over the drug’s safety, regulatory procedures and parents' right to know what treatment their children receive.

Health Minister K Muraleedharan has defended the switch to Natco Pharma's generic risdiplam, which is sold as Natsmart. However, some parents and opposition leaders have questioned why bottles supplied to children at the Sree Avittom Thirunal (SAT) Hospital in Thiruvananthapuram were labelled “Physician's Sample” and “For Clinical Trials Only”.

The controversy has since expanded beyond the medicine's price. It now concerns how the drug reached the hospital and what evidence backs its use in children already receiving treatment.

Why Did Kerala Switch To The Generic SMA Medicine?

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SMA is a rare inherited disorder that causes progressive muscle weakness and wasting because of the loss of motor neurons. It can affect movement, swallowing and breathing. Its treatment may need to continue over a long period.

The branded risdiplam, Evrysdi, is manufactured by Swiss pharmaceutical company Roche. Its reported market price is around ₹6.2 lakh per bottle. Natco's generic alternative, Natsmart, is listed at ₹15,900 per bottle. The Kerala government has negotiated even a lower procurement price.

The difference could substantially reduce public expenditure. The state has been providing risdiplam free to eligible children through its KARE programme. Reports indicate that around 109 children are receiving treatment under the scheme.

The generic switch was intended to make treatment more affordable.. Public health expert B Ekbal has backed the decision, arguing that lower-cost medicines can expand access without compromising quality.

The debate is not over whether generic medicines should be used. Opposition leaders, including former chief minister Pinarayi Vijayan, say their objections concern the handling of the medicine that were labelled for clinical trials and the transparency of its distribution.

‘Clinical Trial’ Label Alarmed The Parents

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The controversy surfaced after families received bottles bearing the clinical trial and physician sample labels. Parents questioned whether their children had been given medicine intended for testing and whether they had adequately informed before.

Former Kerala health minister and CPI(M) leader K K Shailaja raised concerns about quality and the need for transparency and evidence before changing treatment.

“Just because a new company offers a price reduction doesn’t mean we can purchase everything. Besides price reduction, quality is what matters most. Some companies might lower prices just to push unsold products or for other interests,” she said, according to The South First.

The government says the labels indicate that they belong to sample stock and do not mean that the children were enrolled in a clinical trial.

Dr R Shankar, who heads the technical committee that evaluated the medicine, said, “If the concern is over the label, there was ‘physician’s sample’ written on it. It means it is a tested molecule. The container contains the same medicine.”

Hospital authorities said the disputed bottles were taken back after parents raised concerns. The minister has maintained that this was done to address their apprehensions, not because the government had concluded that the medicine was unsafe.

Muraleedharan has said the switch was based on an expert committee's recommendations and that the drug had received regulatory approval.

On October 24, he said, “People had concerns, but the doctors have addressed them. The treating doctors themselves have cleared the doubts.” He also said he would provide further clarification in the state Assembly on October 26.

Also read: Keralam Senior Citizens Bill: What It Means For India’s Ageing Population

SMA Patient Says The Generic Medicine Worked For Her

Amid the concerns, SMA patient Seba P A has defended Natsmart, saying she has taken Natco's generic risdiplam since April through a patient assistance programme. “Taking Natsmart produces the same effect as when I was taking Evrysdi,” she said. “I have felt no issues due to the change in brand.”

Seba also said bottles supplied to her free of cost carried the same physician sample and clinical trial labels. She argued that the labels were intended to prevent the free medicine from being resold.

Is the Generic SMA Drug Safe?

Natsmart contains risdiplam, the same active pharmaceutical ingredient as Evrysdi. The Central Drugs Standard Control Organisation (CDSCO) has approved Natco's formulation for marketing in India.

They maintain that the generic medicine is suitable for patients and that the labels do not indicate an ongoing clinical trial involving the children.

However, questions have been raised about bioequivalence evidence, quality checks and the process followed before procurement. Bioequivalence studies are used to establish whether a generic formulation delivers an active ingredient into the bloodstream at a rate and to an extent comparable with the reference medicine.

The dispute therefore cannot be resolved by comparing prices or relying solely on individual patient experiences. Families need clear information about the product's approval, the evidence for its use in children, the significance of the labels and the safeguards in place to monitor adverse effects.

A combination of two cancer drugs cut the risk of death by 58% in people who have advanced small cell lung cancer, an aggressive form of the disease, according to results from a Phase 3 clinical trial.

The combination pairs Imdelltra (tarlatamab), developed by Amgen, with Imfinzi (durvalumab), an immunotherapy made by AstraZeneca.

In the DeLLphi-305 trial, patients who received both drugs lived a median of 21.1 months, compared to 12.7 months among those who received Imfinzi alone.

The findings were presented at the European Society for Medical Oncology (ESMO) Congress in Madrid on October 24, 2026, and published in The New England Journal of Medicine.

More About Imdelltra-Imfinzi Trial

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The results indicated that using tarlatamab earlier in treatment could be beneficial. It is currently approved in the United States for adults with extensive-stage small cell lung cancer that has progressed during or after platinum-based chemotherapy.

The trial examined its application as a maintenance treatment after patients had completed initial chemotherapy and immunotherapy without their cancer progressing.

“For a disease where durable survival has remained extremely difficult to achieve, the magnitude and consistency of benefit in DeLLphi-305 are striking,” said Jacob Sands, an associate chief of the Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute and an investigator in the trial.

The Phase 3 trial included 563 patients with extensive-stage small cell lung cancer whose disease had not progressed after initial treatment with Imfinzi, platinum-based chemotherapy and etoposide. The main findings were:

- 58% lower risk of death: The combination reduced the risk of death compared to Imfinzi alone.

- 21.1 months median overall survival: This compared to 12.7 months in the Imfinzi-only group.

- Nearly 80% alive at one year: About 79% of patients receiving the combination were alive after 12 months, compared to 53% of those receiving Imfinzi alone.

- 66% lower risk of progression or death: Median progression-free survival was 7.4 months with the combination, versus 1.9 months with Imfinzi alone.

These results indicate that the combination improved both overall survival and the time patients lived without their cancer progressing.

More About The Two Drugs

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Imdelltra, also known as tarlatamab, is a bispecific antibody that brings immune system T cells into contact with cancer cells, helping the immune system recognise and attack them.

Imfinzi, or durvalumab, blocks the PD-L1 protein, which some cancer cells misuse to evade immune attack.

The two drugs therefore target different aspects of the immune response. Researchers hope that combining them will improve the body's ability to control the cancer.

Jay Bradner, Amgen's executive vice-president of research and development, said, “These results represent an unprecedented advance for patients with extensive-stage small cell lung cancer, demonstrating a magnitude of survival benefit rarely seen in this aggressive disease.”

Side effects related to grade 3 or higher treatment occurred in 20.9% of the patients who received the combination, compared to 10.8% of those receiving Imfinzi alone.

Cytokine release syndrome, an inflammatory reaction caused by immune system activation, occurred in 49.6% of patients who received Imdelltra. Most cases were mild or moderate, and one was classified as severe. No deaths were reported.

The findings provide evidence that adding tarlatamab to maintenance immunotherapy can extend survival in extensive-stage small cell lung cancer. The researchers also reported benefits among patients with brain or liver metastases.

Despite promising findings, researchers say that the trial focused on a particular cancer type and treatment. Regulatory authorities will need to examine the evidence adopting this combination for earlier stage of treatment.

The legalisation of recreational marijuana in the United States may have led to increase in hospitalisations for multiple cardiovascular hospitalisations, including heart attacks, heart failure and abnormal heart rhythms, according to a new study published in BMJ Open.

Researchers studied more than 50 million hospital records from 2012 to 2018 and compared cardiovascular hospitalisation patterns in the western United States, where recreational cannabis sales began earlier, with trends in other regions.

They found that hospital admissions for three cardiovascular conditions increased faster in the West after legalisation, sparking questions about the health consequences of legalising recreational marijuana.

The study, titled Cannabis legalisation and cardiovascular hospitalisations in the United States: nationwide difference-in-differences analysis, 2012–2018, was led by Samuel D. Slavin and colleagues.

It analysed records of hospitalisations for acute heart failure, heart attacks, atrial fibrillation, ischaemic stroke, venous thromboembolism and ventricular tachycardia.

Cardiovascular Hospitalisations Increased After Marijuana Legalisation

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The analysis found that, for each additional year of recreational cannabis sales in the western region, hospitalisation rates rose faster than in other regions for these three heart conditions:

• Atrial fibrillation: approximately 2.3% faster per year.
• Heart failure: approximately 3.7% faster per year.
• Heart attacks: approximately 3.1% faster per year.

Atrial fibrillation is an abnormal heart rhythm that can increase the risk of stroke. Heart failure occurs when the heart cannot pump blood effectively to meet the body's needs, while a heart attack occurs when blood flow to the heart is blocked.

Hospitalisation rates for the other conditions also increased, but the differences were not as significant. The researchers say that their study addresses a gap in existing research.

“While several studies have examined the association of recreational cannabis legalisation on psychiatric conditions, substance use, emergency visits, and traffic accidents, ours is the first study to examine the association with cardiovascular hospitalisations,” they wrote.

Cannabis And Heart Health

Cannabis contains compounds that can affect the cardiovascular system. Tetrahydrocannabinol (THC), its main psychoactive component, can increase heart rate and affect blood pressure.

Researchers have also examined links between cannabis use, blood vessel function and blood clot formation. However, cardiovascular effects may vary depending on the product, frequency of use and method of consumption.

The study suggests that legalisation may have wider health implications because it can change the availability and use of cannabis products across a population. However, the researchers did not directly state that cannabis use caused the hospitalisations observed.

The findings show an association between legalisation and changing hospitalisation trends, not cause and effect proof.

The analysis compared regional hospitalisation patterns rather than tracking individual cannabis users. Researchers could not distinguish between different methods of cannabis consumption, examine trends separately for each state or fully account for changes in illegal cannabis use.

The authors said, “While an observational study cannot prove causality, our findings point to potential adverse effects of recreation legalisation on population health.”

They added, “Globally, our findings support a cautious approach to legalisation laws accompanied by data collection on [cardiovascular] outcomes.”