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.

The COVID Cicada variant, currently circulating in 23 countries, is likely to affect children more than the previous variants.

Children have largely escaped severe illness from the SARS-COV-2 virus.

However, the new Cicada variant with around 75 genetic changes in its spike protein is likely to disproportionately affect children, as per an expert, who noted its presence in the UK.

“Some people have done analysis on this, suggesting it may be more prevalent among young children. Children get infections all the time, but this might be something to do with the fact that they have never been exposed to Covid vaccines," Prof Ravindra Gupta, of Cambridge University, who advised the UK government during the pandemic, was quoted as saying to The Mirror.

“So this is something we’re looking at in the lab to try and work out why. The problem with this is that it is an infection that spreads fast. Eventually, it ends up in someone vulnerable," he added.

Key Symptoms

Symptoms seem to be similar to those of other recent variants and include

• sore throat,
• cough,
• congestion,
• fatigue,
• headache
• fever.

Also read: Cicada Variant: Will The Current COVID Vaccine Provide Protection?

What Do The 75 Genetic Changes Mean?

Cicada, a descendant of the Omicron variant that emerged in 2021, was first detected in South Africa in 2024. However, it disappeared soon after, only to emerge early this year.

Prof Gupta told the publication that “the Cicada variant developed the 75 mutations to escape immunity, and it evolved by incubating a single patient for over a year”.

"This 'patient zero' would have been unable to clear the virus due to a compromised immune system," due to HIV or anti-cancer drugs.

Further, he explained that due to 75 mutations to the spike protein, the body’s antibodies will take a longer time to fight the Cicada variant.

However, there is no evidence yet that it is likely to cause more severe disease.

Will The Cicada Variant Cause Severe Illness?

The Cicada variant is particularly concerning as it provides no immune protection to people with previous infection or even vaccination.

Yet, the World Health Organization and health experts advise that existing COVID vaccinations can help prevent severe illness and hospitalization.

"It would appear that all the protections we have from our experience with the virus and with vaccines probably offer more limited—not zero—but more limited protection against this strain," Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center, was quoted as saying by Time.

Also read: COVID Variant BA.3.2 Spreads To 23 Countries: Is The Variant Under Monitoring A Cause Of Worry?

How To Safeguard

Dr. Sai Balasubramanian, a doctor and healthcare strategy executive, writing in Forbes, stressed the need to follow COVID practices such as masks and hand hygiene.

"Healthcare professionals recommend taking general precautions, similar to those used to prevent most viral transmission: get vaccinations when appropriate, wear masks in crowded areas or indoors where there is a high risk of transmission," he said.

He also urged “avoid individuals who have known illness or infections, wash hands frequently, and continue to stay apprised of local community guidelines and the infection spread”.

GLP-1 drugs are powerful tools that can improve health, but it comes with risks and caveats. While these are medical therapies, they are being misused as cosmetic products by cosmetologists, physiotherapists, dermatologists, among others.

To curb its misuse and improve public health, the Indian government today issued guidelines on its use, while also flagging risks around it.

In an official statement issued today, the government has stated that it will roll out stricter inspections to curb the misuse of GLP-1 drugs in the country and will punish those who violate the rules.

“GLP-1 drugs are a significant medical breakthrough in treating type 2 diabetes and obesity, but they are not without risk. The drugs carry a wide range of side effects - from common symptoms like nausea and vomiting to severe complications including pancreatitis, kidney injury, and bowel obstruction. These risks make it essential that GLP-1 drugs are only taken under the supervision of registered medical practitioners/specialists,” the statement said.

In the wake of its hype over weight loss, the country's regulatory authorities have taken firm steps to prevent unsupervised use and malpractices in the supply chain.

It has “strongly advised” patients and the public to” consult a qualified medical specialist before use, and to obtain these medications with prescription only through legitimate, regulated channels”.

“Stricter inspections and surveillance will continue in the coming weeks. Businesses that break the rules will face license cancellation, fines, and legal action,” the statement said.

Also read: GLP-1 Drugs: Why India Needs Stricter Rules Now

What Are The Side-effects Of GLP-1 Drugs?

GLP-1 drugs work to keep food in the digestive system for longer – making people feel fuller for longer, thus reducing appetite and inducing weight loss. Hence, the drugs are also prescribed to people with obesity.

However, when done without clinical oversight, it can lead to severe health complications.

There are various side effects to taking GLP-1 drugs, including nausea and dizziness, to pancreatitis and medullary thyroid cancer.

Some serious side effects include

• Pancreatis
• Thyroid Cancer
• Acute (Sudden) Kidney Injury
• Worsening Diabetes-Related Retinopathy
• Gallstone & Bile Duct Blockage
• Rapid loss of fat in the face
• Wrinkles
• Sunken eyes

GLP-1 medications may also complicate various health conditions, such as allergic reactions, with shortness of breath and low blood sugar.

Rush For Generic Weight Loss Drugs

The government's advisory comes as patent for semaglutide -- an active ingredient in diabetes and anti-obesity drugs, specifically Wegovy and Ozempic -- expired on March 20.

This has led to a rush among Indian pharma companies to launch cheaper generic versions, significantly increasing affordability and access for millions battling Type 2 diabetes and obesity.

Also read: CDSCO threatens action against pharma companies for promoting GLP-1 weight-loss drugs

Major Indian drugmakers who launched their generic semglutide injection in the country in March include Sun Pharmaceutical Industries, Zydus Lifesciences, Alkem Laboratories, and Dr. Reddy’s Laboratories.

WHO Guidelines on GLP-1 drugs

Amid the increasing prevalence of GLP-1 drugs, the World Health Organisation (WHO), late last year, acknowledged its role in treating obesity.

However, it warned that medications like GLP-1 alone will not solve the problem affecting more than one billion people worldwide.

The global health body also issued conditional recommendations for using these therapies as part of a comprehensive approach that includes healthy diets, regular physical activity, and support from health professionals.

Danish pharma giant Novo Nordisk has once again reduced the prices of its blockbuster drugs Ozempic and Wegovy in India. The strategic move is aimed at staying ahead of the entry of the low-cost generic competition in the country.

Starting today, the Ozempic price in India will be cut by 36 percent, while Wegovy has seen a steeper 48 percent reduction — limiting the base price below Rs 6,000 per month.

While Ozempic is available in three dose strengths of 0.25 mg, 0.5 mg, and 1 mg in India, Wegovy has five dose strengths.

Ozempic's and Wegovy's lowest doses of 0.25 ⁠mg will now be priced at Rs 1,415 for a weekly shot from Rs 2,200 and Rs 2,712 earlier, respectively, Novo Nordisk India said in a statement on Tuesday.

The average price reduction across doses is 23.8 percent for Ozempic and 27 percent for Wegovy, it added.

Speaking to the media, Novo Nordisk stated that the price cut will benefit a large section of people with diabetes and obesity in India.

The generic weight loss drugs will open up a huge customer base, especially in India, with a high burden of diabetes and obesity.

Novo first slashed Wegovy's price for the first time by up to 37 percent from its launch price last year.

In addition to the entry of generics, the launch of rival Eli Lilly's blockbuster diabetes and obesity drug Mounjaro in India in 2025.

Also read: Semaglutide Becomes Cheap In India: A Gamechanger Or Health Gamble?

Entry Of Generics In India

Soon after the end of Novo Nordisk's patent on semaglutide, on March 20, a host of companies in India launched generic versions of Ozempic.

This includes NATCO Pharma's Semanat and Semafull, priced at Rs 1,290 per month and Rs 1,750 — about 90 per cent cheaper than Ozempic, costing Rs 8,800 per month.

Eris Lifesciences also announced its plans to launch a multi-dose vial under the brand name Sundae at the same price.

Dr. Reddy’s Laboratories, Sun Pharmaceutical Industries, and Glenmark Pharmaceuticals have also launched their generic versions of semaglutide.

Dr. Reddy’s Obeda is priced at Rs 4,200 per month, available in 2 mg and 4 mg strengths.

Sun Pharmaceutical Industries will sell under the brand names Noveltreat (doses ranging from Rs 900) and Sematrinity (doses ranging from Rs 750). Meanwhile, Glenmark’s GLIPIQ vials range from Rs 325 to Rs 440 per week.

Zydus Lifesciences has also announced the launch of its generic version of semaglutide injection under the brand names SEMAGLYNTM, MASHEMATM, and ALTERMET. The average monthly cost of the treatment will be about Rs 2,200, the company said in a statement.

How Does Semaglutide Work?

Semaglutide works as a GLP-1 receptor agonist that mimics the GLP-1 hormone to regulate appetite and blood sugar. It slows gastric emptying and makes you feel fuller longer. It also signals the brain to reduce hunger and cravings, and triggers the pancreas to release insulin when blood sugar is high.

Also read: This Pill Is More Effective For Weight Loss Than Ozempic, Scientists Say

They work by increasing insulin release in a glucose-dependent manner, decreasing the liver's production of glucagon, and slowing down the emptying of the stomach, which helps lower blood sugar levels after a meal. They also act on the brain to suppress appetite and increase feelings of fullness, leading to reduced calorie intake.

In people with type 2 diabetes, notes Harvard Health, the body's cells are resistant to the effects of insulin and the body does not produce enough insulin, or both. This is when GLP-1 agonists stimulate the pancreas to release insulin and suppress the release of another hormone called glucagon.

These drugs also act in the brain to reduce hunger and act on the stomach to delay emptying, so you feel full for a longer time. These effects can lead to weight loss, which can be an important part of managing diabetes.