Purpose <p>Maternal anxiety, depression, and cognitive changes during pregnancy are recognized as significant public health issues. While previous research has primarily focused on singleton pregnancies, little is known about how twin pregnancies impact maternal mental health and cognitive function. This prospective study aimed to compare anxiety, depression, and cognitive function between women with twin and singleton pregnancies.</p> Methods <p>A total of 160 pregnant women were recruited, including 104 with singleton and 56 with twin pregnancies. Anxiety was assessed using the State-Trait Anxiety Inventory Scale (STAI-S), depression using the Edinburgh Postnatal Depression Scale (EPDS), and cognitive function using the Montreal Cognitive Assessment (MOCA) test.</p> Results <p>Women with twin pregnancies had significantly higher anxiety levels and a higher rate of severe anxiety, with over 50% scoring in the severe anxiety range. Their mean cognitive function scores were significantly lower compared to women with singleton pregnancies. However, depression scores were similar between the two groups. These differences in anxiety and cognitive function remained significant after adjusting for maternal age, BMI, use of psychiatric medications, education level, nulliparity, pregnancy complications, and multifetal gestation.</p> Conclusions <p>Women with twin pregnancies experience greater psychological burden and cognitive decline compared to those with singleton pregnancies. Further research is necessary to explore the long-term effects of these outcomes and to develop interventions aimed at improving mental health and cognitive function in this population.</p>