Eight-month-old twins from Hayward Heath, West Sussex, recently met the surgeon who saved their lives even before they were born. The BBC reports how their mother, Katerina Ahouansou, at six months pregnant, during a routine scan, uncovered a serious issue with their development and blood supply.

Doctors diagnosed the twins with twin-to-twin transfusion syndrome or TTTS. It is a condition where one twin received more blood and nourishment than the other due to uneven blood vessel distribution in the placenta. In case there is no medical intervention, it could be fatal for both the twins.

A Specialist Steps In

This is when Ahouansou was referred to Professor Kypros Nicolaides at King’s College Hospital in London. Professor Nicolaides is a pioneer in fetal medicine and he specializes in a laser procedure that redistributes blood supply between twins in cases of TTTS.

When Ahouansou was scanned, Nicolaides observed that one of the twins were significantly smaller than the other. "There was a very high chance that if we did not intervene, both twins could die," he recalled.

An Operation No Less Than A Miracle

The life-saving laser surgery was performed and within a week the doctors saw an improvement with the twin who was smaller in size. When the twins were born, they weighed 1.5kg and 1.7kg. To recognize the efforts by the surgeon, Ahouansou named them Kai Kypros and Asher Nicolas after Professor Kypros Nicolaides.

Ahouansou also expressed deep gratitude for the professor's expertise and called him "proof that miracles can be performed by people who are devotees to their profession."

Professor Kypros Nicolaides has been at King’s College Hospital since 1980 and is widely regarded as a leader in fetal medicine. His groundbreaking research and development of screening and surgical techniques have saved countless lives.

Through his dedication, Professor Nicolaides has given many families hope, demonstrating how medical advancements continue to improve survival rates for complex fetal conditions like TTTS.

More about Twin-to-twin Transfusion Syndrome

As per the John Hopkins Medicine, TTTS is a rare pregnancy condition that affects identical twins or other multiples. It happens in pregnancies where twins share one placenta and a network of blood vessels that supply oxygen and nutrients essential for development in the womb. These pregnancies are known as monochorionic.

Sometimes, the blood vessels in the placenta are unevenly distributed, causing an imbalance in blood flow between the twins. The donor twin loses more blood than it receives, leading to malnutrition and potential organ failure. Meanwhile, the recipient twin gets an excess of blood, putting strain on the heart and increasing the risk of cardiac complications.

Impact on the Donor Twin

The donor twin loses blood volume (hypovolemia), reducing kidney function and urine production. This leads to low amniotic fluid levels (oligohydramnios) or, in severe cases, a complete absence (anhydramnios). Without proper blood circulation, the donor twin faces cardiovascular issues, increasing the risk of death.

Impact on the Recipient Twin

The recipient twin experiences excess blood volume (hypervolemia), causing increased urination and excessive amniotic fluid (polyhydramnios). The overworked heart struggles to handle the surplus blood, leading to cardiovascular dysfunction, heart failure, and, in extreme cases, death.

Pregnancy is often considered to be a journey that begins with a positive pregnancy test. But medical experts agree that the foundation of a healthy pregnancy is laid much earlier, through preconception care, and strengthened throughout pregnancy with consistent antenatal care. The two stages together are important for the health and well-being of both mother and baby.

Preparing for Parenthood Before Conception (Preconception Care): Why it's important.

Preconception care is the care that happens before a woman becomes pregnant. It involves identifying and managing medical, nutritional and lifestyle factors that may affect pregnancy outcomes. If you’re planning a pregnancy or thinking about getting pregnant in the near future, it’s a good idea to prepare your body in advance to help lower the risk of complications. This is especially important considering that 40–50% of pregnancies worldwide are estimated to be unintended, according to the World Health Organization (WHO).

A preconception health check-up will usually include a review of your medical history, screening for chronic conditions such as diabetes, hypertension, thyroid disorders and anemia, assessment of your vaccination status and discussion of any medications that may not be safe during pregnancy. Doctors also advise women to start taking folic acid supplements at least a month before they conceive to help prevent neural tube defects in the developing baby.

And the healthy lifestyle choices are equally important. Maintaining an ideal weight, following a balanced diet, engaging in regular physical activity, avoiding tobacco and alcohol, and managing stress can improve fertility and contribute to a healthier pregnancy.

Every Check-Up Counts (Antenatal care)

Antenatal care should be routine once pregnancy is confirmed. These regular medical visits allow healthcare providers to monitor the growth and development of the baby and watch the mother’s physical and emotional health. WHO recommends at least 8 antenatal contacts. The guideline was increased from four visits to eight contacts during pregnancy to improve maternal and newborn outcomes and reduce preventable stillbirths.

Blood pressure, weight, blood and urine tests, ultrasound scans and fetal growth are regularly checked during routine antenatal appointments. These tests help to identify potential problems such as gestational diabetes, preeclampsia, anemia, or restrictions in fetal growth early on so that treatments can be given in a timely manner.

Antenatal care also gives valuable advice on nutrition, exercise, sleep, mental well-being, breastfeeding preparation and identifying warning signs that require immediate medical attention. Most importantly, it reassures expectant parents and helps to address concerns throughout pregnancy.

Pregnancy care is not just the expectant mother's responsibility. Partners and families can play an important role in providing a supportive environment, encouraging healthy habits, attending medical appointments when able, and providing emotional support. Having a supportive system can help to lower stress levels and improve maternal mental health, which can contribute to better pregnancy outcomes.

As awareness grows, health care providers are encouraging couples to think beyond the baby bump and prioritize health even before pregnancy begins. With advance planning, regular medical care, fact-based lifestyle choices and prompt treatment, when necessary, you can make a real difference and help ensure that pregnancy is a safer and healthier experience for mother and child.

(Dr. Roli Banthia, Consultant- Obstetrics and Gynaecology, Yatharth Super Speciality Hospital, Noida Extension)

Riya and Karan (name changed), both working professionals from Indirapuram, Ghaziabad, often unwind at night by watching reels after putting their 6-year-old son, Aarav, to bed. What began as “just 20 minutes” regularly stretched to 1–2 hours. Over time, Aarav started asking for the phone at dinner. Soon, he insisted on watching reels before sleeping. Tantrums increased when the phone was taken away.

Within months, Aarav’s sleep was delayed by 1–1.5 hours. He woke up cranky and tired for school, and schoolteachers noticed a reduced attention span. He became impatient and easily irritable. His parents realized he was not just watching — he was hooked on fast-paced short videos.

What Is Happening?

Do you know that our children mirror parental behavior? Fast, high-stimulation reels overstimulate the brain. Night screen exposure disrupted melatonin and sleep cycles. Reduced parent-child interaction impacted emotional regulation. We need to understand that sleep is not a passive state of rest; it is an active biological process that is essential for physical growth, brain development, emotional regulation, and overall well-being. In children, adequate and high-quality sleep is as important as proper nutrition and immunization. Unfortunately, pediatric sleep is often neglected, misunderstood, or sacrificed in modern lifestyles.

What Is Normal Pediatric Sleep?

Normal sleep varies with age and follows predictable developmental patterns.

• Newborns (0–3 months): 14–17 hours per day, fragmented into multiple sleep periods.
• Infants (4–12 months): 12–16 hours, with gradual consolidation of night sleep.
• Toddlers (1–2 years): 11–14 hours, including 1–2 daytime naps.
• Preschool children (3–5 years): 10–13 hours, often with one nap.
• School-age children (6–12 years): 9–12 hours, usually no naps.
• Adolescents (13–18 years): 8–10 hours, with a natural tendency toward later sleep and wake times.

Normal sleep is regular, age-appropriate in duration, refreshing, and uninterrupted, allowing the child to wake up alert and active during the day.

How To Promote Normal Sleep In Children

Healthy sleep habits, often referred to as sleep hygiene, are the cornerstone of normal pediatric sleep.

Key strategies include:

• Maintaining a fixed bedtime and wake-up time, even on weekends.
• Establishing a calm and predictable bedtime routine (bath, reading, prayer, or quiet conversation).
• Ensuring the sleep environment is dark, quiet, cool, and comfortable.
• Avoiding screen exposure (mobile phones, tablets, television) at least 1–2 hours before bedtime.
• Encouraging daytime physical activity and exposure to natural daylight.
• Avoid heavy meals, caffeine, or sugary drinks close to bedtime.
• Consistency is critical. Children thrive on routine, and predictable sleep schedules reinforce the body’s internal clock.

Home Remedies to Support Better Sleep

Simple, non-pharmacological measures at home can significantly improve sleep quality:

• Warm bath or gentle massage before bedtime to promote relaxation.
• Storytelling or reading can help transition from stimulation to calmness.
• Soft music or white noise for children who have difficulty settling.
• Comfort objects (a favorite toy or blanket) for younger children.
• Teaching relaxation techniques such as deep breathing to older children.
• Limiting late-evening academic pressure or emotionally charged discussions.

Importantly, sleeping pills or sedatives should never be used without medical advice.

Why Sleep Is Crucial for Growth and Development

Sleep plays a central role in nearly every aspect of child development:

• Growth hormone secretion peaks during deep sleep, directly influencing height and physical development.
• Brain maturation and learning depend on sleep for memory consolidation and neural connectivity.
• Immune function is strengthened during sleep, reducing infection risk.
• Emotional regulation improves with adequate sleep, reducing irritability and mood swings.
• Metabolic health is protected, lowering the risk of obesity and insulin resistance.

Chronic sleep deprivation disrupts these processes, with long-term consequences.

Common Pediatric Sleep Disorders

Pediatric sleep disorders are common and often under-recognized. They include:

• Behavioral insomnia of childhood (difficulty falling or staying asleep due to habits).
• Sleep-disordered breathing, including obstructive sleep apnea.
• Parasomnias such as night terrors, sleepwalking, and confusional arousals.
• Restless sleep disorders, including restless legs syndrome.
• Circadian rhythm disorders are particularly prevalent in adolescents.
• Early recognition and treatment are essential to prevent secondary behavioral and academic problems.

Relationship Between Sleep and Behavioral Disturbance

There is a strong and well-established link between poor sleep and behavioral issues in children.

Sleep-deprived children may present with:

• Hyperactivity and impulsivity (often mimicking ADHD)
• Inattention and poor academic performance
• Irritability, aggression, and emotional outbursts
• Anxiety and depressive symptoms
• Poor social interaction and reduced empathy

Future Consequences: Sleep, Aggression, and Crime

The long-term consequences of untreated sleep disorders extend beyond childhood:

• Chronic sleep deprivation affects impulse control, judgment, and emotional regulation.
• Adolescents with persistent sleep problems show higher rates of risk-taking behavior, substance use, and aggression.
• Longitudinal studies suggest associations between poor childhood sleep, antisocial behavior, and later involvement in violence or crime.
• Sleep deprivation impairs moral reasoning and increases reactive aggression, particularly in socially vulnerable populations.

Healthy sleep is a foundational pillar of pediatric health, equal in importance to nutrition, education, and emotional security. Promoting normal sleep from early childhood can improve behavior, academic success, mental health, and even societal outcomes in adulthood. Parents, schools, and healthcare providers must work together to recognize sleep as a priority—not a luxury—for every child.

Early investment in healthy sleep is an investment in healthier individuals and a safer society.

(By Dr Tanuj Kumar Verma, Consultant, Pediatric Intervention Pulmonologist and Intensivist at Cloudnine Group of Hospitals, Indirapuram)

A new study published in The Lancet Obstetrics, Gynaecology, & Women's Health has revealed an alarming rise in infertility rates among women aged 35 years and older.

The analysis, based on the Global Burden of Disease Study 2023, found that global female infertility could affect nearly 80 million women aged 35–49 by 2036 if current trends continue.

In 2023, an estimated 53.60 million women aged 35–49 were affected by infertility. Nearly 54 million women in this age group sought fertility care, including fertility testing and assisted reproductive technologies such as in vitro fertilization (IVF).

Asia Bears Highest Burden

According to the study, Asia has the highest need for fertility care particularly East Asia reported the highest regional burden, while Australasia has the lowest. At country level, the Central African Republic had the highest reported burden, while Nepal had the lowest.

Although disparities between low- and high-income regions have narrowed, the burden is shifting toward high-income settings, where women are more likely to delay pregnancy and seek fertility testing and treatment.

Also read: AI Now Reading Sperm, Giving Hope of Fatherhood to Infertile Men

The researchers said, "This shift reflects broader social and economic changes, including delayed family planning and greater access to fertility services in some affluent regions".

"Advanced-age female infertility represents a growing global health challenge. Despite improved regional equity, low-SDI countries continue to face significant burdens. This necessitates implementing tailored public health strategies and prioritizing resource allocation to mitigate future burdens," said the researchers from China, Hong Kong, and Singapore in the paper.

To address the rising demand, the authors called for

• expanding and integrating fertility services into primary health care, reducing financial barriers to treatment,
• using innovative delivery methods,
• mobile health tools,
• improve equitable access to fertility care.

Infertility A Growing Global Health Concern

The World Health Organization defines infertility as the failure to achieve a clinical pregnancy after 12 months of regular unprotected intercourse.

Approximately 8–12 per cent of reproductive-aged couples worldwide experience infertility, with the burden disproportionately affecting women aged 35–49 years.

Read More: Yoga May Boost Fertility And Hormonal Health In Women With PCOS, Finds AIIMS Studies

The study noted that this higher risk is largely biological, driven by age-related declines in ovarian reserve and oocyte quality, which reduce natural fertility, increase miscarriage risk, and lower the success rates of assisted reproductive technologies (ART).

As populations age and socioeconomic transitions continue, the number of women exposed to advanced-age infertility risk is increasing, making it an increasingly important public health issue.

How Was The Study Conducted?

The researchers analyzed data from the Global Burden of Disease (GBD) 2023 study to provide what they describe as the first comprehensive assessment of infertility among women aged 35–49 across 204 countries and territories.

Since 1990, both the age-standardized prevalence rate and disability-adjusted life years (DALYs) attributable to infertility have risen steadily, by 0.45 per cent and 0.47 per cent every year, respectively.

The study projects that infertility cases in women aged 35–49 will continue to rise, reaching nearly 80 million by 2036 in the absence of targeted interventions.

The researchers also found a 23.10% reduction in the relative disparity in infertility-related DALYs between low- and high-Socio-demographic Index (SDI) regions since 1990, indicating progress in equity while highlighting persistent structural gaps in access to care.