TNFSF11 and hypercalcemia disease: The risk of hypercalcemia may be even greater in multiple pregnancies, likely due to increased 1α-hydroxylase production from two placentas and increased bone resorption via receptor activator of nuclear factor-kappa B ligand (RANKL) activation by 1,25(OH)2D.10 Aggressive management of hypercalcemia has been shown to improve both maternal and neonatal outcomes, reducing risk of preeclampsia, symptomatic hypercalcemia, and neonatal nephrocalcinosis.8 In our case, proactive treatment in the second pregnancy resulted in a later delivery compared to the index pregnancy.