Objective:To examine the association between nutritional status of pregnant mothers and the risk of astigmatism in twins. Methods:Twenty-eight twin pairs were recruited from Jiangsu Province Hospital. Noncycloplegic refraction was measured by vision screening instrument 3 and 6 months after birth. Detailed perinatal history and postnatal data were collected. The relationship between astigmatism and related factors of pregnant mothers and infants was analyzed. Meanwhile 56 cases of singleton were randomly selected as control group. Results:Detection rate of astigmatism in observed twins’ group was 53.57% (cylinder power of 2.0 D or worse),which was significantly higher than that of their parents (14.28%,cylinder power of 1.0 D or worse),and that of singletons. The values of astigmatism were correlated with family history. Morning sickness(OR=1.40,95%CI=1.10~5.13),BMD(OR =1.44,95%CI=1.30~6.19) and haemoglobin(OR=1.40,95%CI=1.03~2.78) of mother during mid-pregnancy,maternal serum magnesium (OR=1.39,95%CI=1.03~1.89) and vitamine A during delivery (OR=1.03,95%CI=1.01~1.05),Umbilical vein vitamine D(OR=1.02,95%CI=1.00~1.04),birth weight(OR=1.02,95%CI=1.00~1.03) were correlated(P < 0.05)with the formation of twins astigmatism. Conclusion:Detection rate of twins astigmatism was significantly higher than that of singletons. The formation of astigmatism in twins was related with the level of maternal and fetal nutrition and other factors,noticeably morthers’ morning sickness,haemoglobin and twins’ birth weight. Further studies are warranted. Corresponding nutrition instruction should be given to pregnant women to decrease the risk of astigmatism.