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.

Nearly 76,805 children and adolescents in India are estimated to develop cancer each year. At the same time, childhood cancer can be highly treatable when diagnosed early and managed appropriately, with survival exceeding 80% in settings where timely diagnosis and comprehensive treatment are available.

When people think about preventive healthcare for children, the conversation usually centers on vaccinations, good nutrition, physical activity, sleep and regular health check-ups. These are important for a child’s overall health. But prevention also involves something that is often overlooked: recognizing when a child’s health is changing and seeking medical advice at the right time.

Childhood cancer is different from many cancers seen in adults. In most cases, there is no clear lifestyle-related cause that parents could have avoided. A child developing cancer is therefore not usually linked to something the parents did or did not do. This is important because there is no particular diet, exercise routine or supplement that can guarantee protection against childhood cancer.

The Importance of Recognizing a Pattern

For doctors, one of the more practical ways to improve outcomes is to recognize when a seemingly common symptom is not following its usual course. Fever, tiredness, headaches, loss of appetite or body pain are frequent childhood complaints. But when they persist, keep returning or occur alongside other changes, they should not simply be treated repeatedly without evaluation.

• Unexplained weight loss

• Unusual bruising or bleeding

• Persistent bone or abdominal pain

• A growing lump or swelling

• Repeated headaches

• Changes in vision

These are some signs that may require further assessment. These symptoms are not specific to cancer, but their persistence warrants attention.

Why Early Diagnosis Matters

Most childhood cancers do not have a routine screening test for healthy children. Diagnosis therefore often depends on noticing an unusual pattern and investigating it appropriately.

A delay does not necessarily mean that cancer has been missed, but prolonged delays can allow some cancers to progress before treatment begins. For this reason, awareness among parents and healthcare providers, timely evaluation and appropriate referral are important parts of childhood cancer care.

Prevention Is Not Just About Avoiding Cancer

Vaccination still has a place in the broader cancer-prevention conversation. Hepatitis B vaccination helps reduce the risk of liver cancer linked to chronic hepatitis B infection, while HPV vaccination can help prevent HPV-related cancers later in life. However, these vaccines do not prevent most cancers that occur during childhood.

Similarly, nutrition should be viewed in the right context. A balanced diet supports growth and recovery, including during cancer treatment, but there is no specific food or diet that can prevent a cancer.

The Cost of Childhood Cancer

Childhood cancer can place a significant financial and practical burden on families. Treatment costs may be accompanied by expenses related to travel, accommodation, food and time away from work.

At the same time, families today have more avenues of support than before. Government health schemes, public healthcare facilities and non-government organizations can help with treatment costs and other practical needs. The challenge is ensuring that families are aware of these resources and can access them early enough.

Looking Beyond Treatment

Children who survive cancer may need long-term monitoring for possible effects of treatment on growth, development and other aspects of health.

For childhood cancer, therefore, prevention is less about finding a way to eliminate risk and more about reducing what can be changed: delayed diagnosis, interruptions in treatment and avoidable long-term complications..

(Dr Amita Mahajan, Senior Consultant, Pediatric Oncology, Indraprastha Apollo Hospital, Delhi)

A baby's first protection against serious infections begins even before birth. Timely maternal vaccination during pregnancy helps pass protective antibodies from mother to baby, offering valuable immunity during the first few months of life.

Many parents believe that a baby's vaccination journey starts only after birth. However, doctors say a baby's first protection actually begins during pregnancy. During the third trimester, a mother's body naturally passes protective antibodies to her baby through the placenta.

These antibodies help protect newborns from certain infections during the first few months of life, when their immune system is still developing and before their own vaccines provide full protection. Maternal immunisation not only protects the mother from serious illnesses during pregnancy but also gives the baby a healthy start. Yet, many expectant mothers are aware only of the tetanus-containing vaccine (Td) and may not know about other important vaccines or health checks that can benefit both mother and child.

How does a baby get protection before birth?

During pregnancy, especially in the last three months, antibodies produced by the mother's immune system cross the placenta and enter the baby's bloodstream. These antibodies act as the baby's first line of defence after birth.

Since newborn babies have immature immune systems, this natural transfer of immunity helps lower the risk of severe infections during the early weeks and months of life. This protection is temporary, which is why babies still need to receive all their routine childhood vaccinations on time after birth.

Also read: Trying For A Baby? Tobacco Smoking Hurting Male And Female Fertility, Warns WHO

Which vaccines are important during pregnancy?

Doctors commonly recommend the Td (Tetanus and Diphtheria) vaccine during pregnancy to protect both the mother and baby from tetanus. Depending on the mother's medical condition, vaccination history, and local recommendations, doctors may also advise the Tdap vaccine, which protects against tetanus, diphtheria, and whooping cough (pertussis).

In some situations, the influenza (flu) vaccine may also be recommended, particularly during flu season or for women at higher risk of complications. Another important step is rubella screening before pregnancy. Rubella infection during early pregnancy can lead to serious birth defects. Women planning pregnancy should ensure they are protected against rubella before conceiving, as the vaccine is not given during pregnancy.

Also read: Are Children Breathing Clean Air Inside Classrooms? New European Study Raises Concern

Why maternal vaccination matters?

Vaccination during pregnancy helps reduce the mother's risk of certain infections, lowering the chances of illness-related complications during pregnancy. At the same time, it allows protective antibodies to reach the baby before birth, providing valuable immunity until the infant begins receiving routine childhood vaccines.

Discuss vaccination early during antenatal visits so that recommended vaccines can be given at the appropriate time. Every pregnancy is unique, and vaccination decisions should always be made in consultation with the doctor.

Tips for expectant mothers

• Discuss recommended vaccines during your very first antenatal visit.

• Receive the Td vaccine as advised by your doctor.

• Ask your doctor whether the Tdap vaccine is recommended in your pregnancy.

• If advised, get the influenza vaccine during pregnancy.

• If planning a pregnancy, get screened for rubella immunity and complete vaccination before conception if needed.

• Attend all regular prenatal check-ups.

• Follow a healthy diet, stay physically active as advised, and get adequate rest.

• Continue your baby's routine vaccination schedule after birth without delay.

By discussing immunisation early in pregnancy and following medical advice, parents can give their newborn an important layer of protection even before the first cry.

Globally, one in six people of reproductive age experiences infertility at some point in their lifetime. Smoking is one of the key reasons for infertility among men and women worldwide, according to a new World Health Organization (WHO) knowledge summary.

The report, the 12th in a series of Tobacco Knowledge Summaries, highlights evidence linking tobacco use to infertility in women, harmful effects on sperm and sexual function in men, and potentially lower chances of success with some fertility treatments. It also warns that second-hand smoke may affect reproductive health.

Infertility is defined as the failure to achieve pregnancy after 12 months or more of regular unprotected sex.

What Does the WHO Report Say?

Infertility can have multiple causes. However, cigarette smoking and exposure to second-hand tobacco smoke are associated with infertility in women.

The harmful effects of cigarette smoking on women’s reproductive health are well documented, while evidence on other tobacco products, including waterpipe and smokeless tobacco, as well as nicotine products such as e-cigarettes, is still emerging.

Current data suggest potential risks to fertility, but further research is needed to fully understand these effects. Among

men, cigarette smoking is associated with harmful effects on semen and sperm, as well as sexual function, which can contribute to infertility.

On the other hand, women who quit smoking may have a lower risk of infertility compared with women who continue to smoke.

WHO recommends that healthcare providers inform individuals and couples planning pregnancy about the reproductive risks of tobacco use and offer evidence-based support to help them quit.

How Smoking Affects Fertility?

“Smoking is an important fertility consideration for both men and women. It can affect the quality of both eggs and sperm, and the concern is not limited to people who smoke themselves,” Dr Neelam Suri, Senior Consultant, Obstetrics & Gynecology, Indraprastha Apollo Hospital, Delhi, told HealthandMe.

Smoking also accelerates follicular depletion, which may contribute to an earlier onset of menopause compared with women who do not smoke.

Second-hand smoke can expose individuals to harmful substances that may affect reproductive health. Eggs and sperm are rapidly developing cells, and exposure to tobacco smoke can increase the risk of DNA damage and other cellular changes that may affect fertility and reproductive outcomes.

Dr Shalu , Senior Clinical Director, Cloudnine Group of Hospitals, Gurugram, told HealthandMe that while passive smoking may not directly cause infertility in every individual, regular exposure to tobacco smoke can affect reproductive health and have significant implications during pregnancy.

These include ectopic pregnancy, miscarriage, preterm birth, pre-eclampsia, fetal growth restriction, low birth weight, stillbirth, placental complications and neonatal complications.

Regular exposure to second-hand smoke may also potentially influence the chances of success with fertility treatments such as IVF.

“This is particularly relevant for couples undergoing IVF, where egg and sperm quality can influence the chances of successful treatment,” Dr Suri said.

What Should Couples Planning Pregnancy Do?

For couples planning a pregnancy or undergoing fertility treatment, avoiding tobacco smoke is an important step towards protecting reproductive health.

This means quitting smoking and maintaining a smoke-free environment at home to reduce regular exposure to cigarette smoke.

At the same time, fertility depends on multiple factors. Exposure to second-hand smoke does not necessarily mean a couple will experience infertility or IVF failure. However, reducing preventable risk factors can be beneficial when trying to conceive.

Ideally, couples should create a smoke-free environment before conception rather than waiting until fertility difficulties emerge.