Twin pregnancies pose significant challenges to maternal medicine due to the heightened risk of complications for both the mother and fetuses. This chapter explores the maternal complications associated with twin pregnancies, including hypertensive disorders, gestational diabetes, preterm birth, miscarriage, and intrauterine fetal demise (IUFD). The distinction between monochorionic and dichorionic twins is emphasized, highlighting the unique risks associated with each type. Additionally, the chapter addresses the psychological impact on mothers and underscores the importance of tailored care and mental health support for women undergoing high-risk twin pregnancies.