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.

After a recent Supreme Court of India order banning the use of stem cell therapy to treat autism -- a neurodevelopmental condition affecting communication, social interaction, and behavior -- the country's National Medical Commission has issued a clear warning to doctors and hospitals not to use the therapy to treat autism in routine medical practice.

The National Medical Commission, in a new advisory, asked all medical colleges, hospitals, and doctors to strictly follow the rules.

In a letter sent to the regulator, Indian Council of Medical Research Director-General Dr. Rajiv Bahl stated that the stem cell treatment can now be used in regular medical practice only for 32 diseases that are officially approved by the government. These include blood cancers and serious blood disorders such as:

Acute myeloid leukemia

Thalassemia

Multiple myeloma

Aplastic anemia

Myelofibrosis

Germ cell tumors.

The letter asked doctors not to offer stem cell therapy for any other disease outside this list.

Notably, the Ethics and Medical Registration Board (EMRB), under the National Medical Commission (NMC), had, in December 2022, constituted the Committee on Stem Cell Use in Autism Spectrum Disorder (ASD).

It had stated that none of the current international guidelines recommend stem cell therapy as a treatment for ASD and added that the therapy is not recommended as a treatment for ASD in clinical practice.

Also read: Japan Approves First-Ever Stem Cell Therapies For Parkinson’s And Heart Failure

What Was The Supreme Court Ruling On Stem Cells?

Earlier this year, in January, a bench comprising Justice JB Pardiwala and Justice R Mahadevan noted that stem cell therapy lacks “scientific support and has not been recognized as a sound medical practice backed by empirical evidence”.

The Bench ruled that “every use of stem cells in patients outside an approved clinical trial is unethical and shall be considered as malpractice.”

The apex Court, however, added that the advanced therapy, which holds promise in several medical fields, can still be approved for monitored clinical research trials. It added that the patients have the liberty to participate in approved and regulated clinical trials.

What Is Stem Cell Therapy

Stem cell therapy, also called regenerative medicine, is a medical treatment that uses stem cells to repair or replace damaged tissues.

While the therapy is useful and effective for blood cancers and autoimmune diseases, for the treatment of autism, there is no proof or scientific evidence of its utility.

As stem cell therapy is vastly unregulated in India, many private labs have been minting money over the promise of treatment for autism.

“Most stem cell therapies are unregulated in India and are promoted based on no evidence, and fake advertisements. While these disorders have no cure, many people are falsely lured by these companies,” Dr. Manjari Tripathi, Head of Department, Neurology, AIIMS Delhi, had told IANS, after the SC verdict.

Also read: New Stem Cell Transplant Breakthrough Could Replace Chemo In Cancer Treatment

Stem Cells Permissible Only For Research

The NMC warned that any doctor or institution offering stem cell therapy for autism will face regulatory and legal action.

The top medical regulator, however, stated that stem cell therapy is permissible only for research purposes.

Such studies must follow strict rules set by the government and must be approved by ethics committees and national regulatory bodies.

Researchers must also ensure that patients give written consent, that treatment is provided free during the trial, and compensation is offered if injury or death occurs during research.

Florida on Tuesday approved nearly $31 million in short-term funding for H.I.V. medication for residents This is a reverse course after the state health officials restricted the access to a program that helps only those who could afford costly medications.

What Happened In The Past?

The Florida Department of Health had imposed tougher eligibility rules on March 1 that left 12,000 residents with H.I.V. without the access to medication covered by the state's AIDS Drug Assistance Program. This deprived them of life saving drugs, noted a nonprofit advocacy group - AIDS Healthcare Foundation.

The foundation also sued the department over these changes with protestors rallying in opposition at the State Capitol in Tallahassee. The department cited a projected $120 million state budget that restricted eligibility for the program.

Read: HIV vs. AIDS: What You Should Know About These Commonly Confused Terms

Yet, the Florida House of Representatives and State Senate, both led by Republicans, unanimously approved legislation that provides $30.9 million to fund the program through June 30 and restore the eligibility rules. Gov. Ron DeSantis, a Republican, signed the bill into law on Tuesday.

“Lawmakers on both sides understood the urgency of the crisis,” State Senator Carlos Guillermo Smith, a Democrat from Orlando who spoke out in support of the bill on the floor, said in an interview on Wednesday. “It is a matter of life and death. People had already lost access to their medications.”

Restriction On AIDS Drug Assistance Programs

As per an analysis by KFF - a health research group, Florida was one of the nearly 20 states, led both by Republicans and Democrats that imposed restrictions on AIDS Drug Assistance Programs.

The programs cover the cost of H.I.V. medications, which can run into thousands of dollars each month. They provide drugs free to some individuals and help others by paying their insurance premiums. Overall, they support about a quarter of the 1.2 million people living with H.I.V. in the United States.

However, these programs are under growing pressure. The cost of H.I.V. medications continues to rise, and the expiration of health care subsidies has led to a sharp increase in insurance premiums. Despite this, federal funding for these programs has remained largely unchanged for more than a decade.

In Florida, the Department of Health had reduced eligibility for the state’s AIDS Drug Assistance Program to 130 percent of the federal poverty level, which is about $20,748 a year for an individual, down from 400 percent or $63,840. A new law has now reversed this change, restoring eligibility back to the 400 percent threshold.

“For 10 weeks, 12,000 Floridians living with H.I.V. did not know if they could fill their next prescription,” Esteban Wood, the director of advocacy and legislative affairs at the AIDS Healthcare Foundation, said in a statement on Tuesday. “Today, they can.”

The US Food and Drug Administration (FDA) has approved a drug therapy to address neurologic symptoms of a rare genetic disorder — Hunter syndrome.

The X-chromosome-linked disease, occurring predominantly in males, has an estimated 2,000 affected individuals worldwide.

The drug Avlayah, developed by pharma company Denali Therapeutics, targets certain individuals with Hunter syndrome (Mucopolysaccharidosis type II or MPS II).

It is the first therapy to address the neurologic complications of Hunter Syndrome, such as

• progressive cognitive decline,
• behavioral problems,
• hydrocephalus,
• spinal cord compression,
• seizures,
• carpal tunnel syndrome.

“Today is a milestone day for children and their families battling Hunter syndrome,” said FDA Commissioner Marty Makary, in a statement.

“Avlayah is the first product approved to address neurologic complications of Hunter Syndrome, a very rare and often severe X-linked disorder in children, affecting about 500 people in the US, almost exclusively males,” added Acting CDER Director Dr. Tracy Beth Hoeg.

The FDA noted that Avlayah, the once-weekly drug given via IV infusion, must begin in presymptomatic or symptomatic pediatric patients weighing at least 5 kg before advanced neurologic impairment.

What Is Hunter Syndrome?

Hunter syndrome is a rare inherited lysosomal disorder in which sugar molecules called glycosaminoglycans build up within the cells’ lysosomes.

The condition affects physical and mental development and causes abnormalities in the skeleton, heart, respiratory system, brain, and other organs.

Hunter syndrome is a rare congenital metabolic disease. It was first reported in 1917 by a Canadian physician, Charles Hunter, in two brothers in a family.

The brothers presented typical signs, such as

• short stature,
• inguinal hernia,
• macroglossia,
• enlarged skull,
• decreased hearing,
• coarse facial features,
• protruded abdomen with hepatosplenomegaly,
• umbilical hernia,
• skeletal deformities.

The younger brother had symptoms of Central Nervous System (CNS), including seizures and cognitive decline, while the older brother did not have CNS involvement.

The estimated incidence is 1 in 162,000 live male births.

How The FDA Approved Avlayah

The FDA approval came after Avlayah showed promise in reducing cerebrospinal fluid heparan sulfate — one of the glycosaminoglycans that accumulates in the body in this disorder and is linked to the organ damage that occurs in early childhood.

The phase 1/2 multi-cohort, single-arm, open-label trial enrolled 47 pediatric patients with Hunter syndrome aged 3 months to 13 years.

Of these, 44 patients with measurements at had a 91 percent average decrease from baseline in CSF.

Denali is now conducting a randomized clinical trial that is more than 95 percent enrolled to evaluate the clinical benefit of this product.

"In the meantime, families with young children with Hunter Syndrome will have access to a product that may favorably alter the course of the disease at the crucial time in life when there is the greatest potential for benefit," Hoeg said.

Are There Any Side Effects?

Avlayah’s labeling includes a boxed warning for allergic reactions, including anaphylaxis, associated with the drug.

The FDA recommended that patients start therapy in a health care setting with appropriate medical monitoring and support measures.

The common side effects of Avlayah include

• upper respiratory tract infection,
• ear infection,
• fever,
• anemia,
• cough,
• vomiting,
• diarrhea,
• rash,
• COVID-19,
• runny nose,
• nasal congestion,
• fall,
• headache,
• skin abrasion,
• hives.

The FDA also suggested that healthcare workers monitor

• hemoglobin levels due to the risk of anemia,
• kidney function and urine protein levels due to
• the risk of membranous nephropathy (a kidney disease).