Healthcare providers predominantly focus on acute medical problems in multiple pregnancies. However, many conditions, such as preterm birth, excessive weight gain, hypertensive disorders in pregnancy or gestational diabetes, represent basic maternal health conditions and can act as a “window for future health” with a long-term perspective for the future health of mothers and their offspring. In addition, increasing maternal age represents a “stress test” for their metabolic, cardiovascular, and mental health. Fetal programming during the most vulnerable developmental period has implications for the offspring. Regrettably, long-term studies evaluating cohorts with purely multiple pregnancies are scarce. Nevertheless, data from singletons or mixed cohorts increase our awareness of these associations. Women with threatening premature birth, fetal growth retardation, and excessive weight gain during pregnancy, HDP or GDM should be identified and counselled about their increased risk of later coronary disease, heart attack, stroke or even earlier death, overweight, and diabetes, respectively. Therefore, an adapted follow-up of blood pressure, blood sugar, and weight controls in pregnancies with high body mass index or excessive gestational weight gain should be the standard of care. MFM specialists should increasingly focus on counselling women already during pregnancy about the eventual stratification of their postpartum follow-up.