Amina Tsoi’s twin babies are healthy girls. They squabble, as siblings do, and they both have a curious appetite for cheese, “like little mice,” their mother says. But they are small for 1-year-olds, a legacy of their premature birth during the first weeks of Russia’s invasion of Ukraine.

For seven months, Ms. Tsoi had enjoyed a happy and healthy pregnancy, largely without complications. Then one February morning last year, explosions boomed through the town where she was living, near Mykolaiv, in southern Ukraine, which faced increasing missile strikes and ground skirmishes.

“My mother-in-law entered our room and said, ‘The war has started,’” Ms. Tsoi said. “And I started to panic.”

Ms. Tsoi, then age 20, escaped any bombardment and was seemingly unharmed. But in the ensuing days, she lost the sight in one eye and gained 14 pounds because she was retaining water. After she had an emergency cesarean section, during which she lost enough blood to require two transfusions, her daughters, born six weeks premature, clung to life in incubators.

Russia’s invasion of Ukraine has killed tens of thousands of soldiers and civilians, and wounded many thousands more. The mental burden of the war has also exacted a heavy toll. For pregnant women, the stress can be particularly dangerous, with doctors and hospital officials warning about a sharp increase in maternal health problems such as premature births.

Babies born before full term are more likely to develop respiratory, neurological and digestive complications. Those born particularly prematurely can have severe physical and mental health problems. Twins or other multiple births are susceptible to being born early, even in normal times.

After more than a year of war, official statistics about maternal health in Ukraine are sparse. Figures about premature births, for example, can be misleading because so many pregnant women, particularly those with health problems, were evacuated to other countries after Russia’s invasion began. But doctors in several interviews, particularly in areas close to the fighting, reported elevated rates of premature birth, increased instances of high blood pressure during pregnancy and a higher rate of C-sections, blaming the complications on the extraordinary strain of bearing a child at a time of danger and dislocation.

“We can see that the course of pregnancy became harder,” said Dr. Liudmyla Solodzhuk, 58, medical director at a hospital in Mykolaiv, a city close to the front line. “Usually the birth of a new human is happiness, and now it’s anxiety,” she added.

The effort to shield pregnant women from the tensions of war has become a medical priority, Dr. Solodzhuk noted, with medical staff trying novel ways of distracting patients from the brutal sounds of the war outside.

“We have been saying that the shelling is fireworks,” she said, “in honor of their children’s birth.”

Dr. Solodzhuk’s hospital in Mykolaiv has reported that the number of C-sections and early births has increased by 5 percent. Government statistics show smaller increases in premature births in the wider Mykolaiv region and in other parts of southern and eastern Ukraine, where the fighting is most intense, but those figures are complicated by the large numbers of residents who have fled.

The musical duo Tvorchi, Ukraine’s entry in the Eurovision Song Contest in Liverpool, England, last month, gave the issue further exposure when, at a red-carpet event in the prelude to the competition, the performers wore suits with the names and weights of babies born early.

For the pregnant women who stayed after Russia’s invasion, any hopes that the fighting would be over quickly proved wishful.

Inna Harbuz, then 30, was pregnant with twin boys and living in Mykolaiv when Russian missiles began striking the city. Her family decided it would be safer to move elsewhere, only for an early Russian advance to take the nearby village where they had gone. As much as possible, the family tried to stay out of sight.

“We started hiding in the cellar every day, being mostly scared that the Russians would find us,” Ms. Harbuz said, adding that the fear of being discovered by the invading troops was worse than facing the rocket fire in Mykolaiv.

On Oct. 28, Ms. Harbuz suffered internal bleeding from a prematurely detached placenta. By that time, the Russian troops had been pushed back from the village, and her family rushed her to a hospital in Mykolaiv where she underwent an emergency C-section. Her twin sons, born prematurely, were placed on breathing support.

Some seven months later, both boys are doing well. But the family has decided to stay in the village rather than return to Mykolaiv, which still comes under regular bombardment.

After Ms. Tsoi’s twin girls were born, they had health issues, and she said that she needed to regularly check their heart rates, eyesight and weight. At 9 months old, they still could not stand and the family was getting worried, but “they both are running now,” she said recently.

Ms. Tsoi blames the war for turning her pregnancy into such an ordeal. Even during her C-section, the conflict was inescapable. “I started crying on the surgery table,” she said. “It was very scary because I could hear lots of explosions and shooting outside.”

She was reunited with her daughters only on the eighth day after giving birth. At that time, they were still being fed through tubes and the fighting outside was worsening. At one point, the hospital staff and patients were forced to cram together into the basement for safety.

The traumatic experience was almost too much for Ms. Tsoi. “Within a month, I had a horrible breakdown,” she said. “I shouted at my husband to get us out abroad, otherwise I can’t handle it, I will just not survive.”

Ms. Tsoi’s husband drove the family to the border with Moldova, but he had to return to Ukraine as men of fighting age are not allowed to leave.

A few months later, Ms. Tsoi and her daughters moved back to Ukraine and rented a house near Odesa to be nearer to her husband. The girls are healthy, but they are behind the normal growth and development goals for their age.

For Ms. Tsoi, the war turned her pregnancy from a joyous experience into one she would prefer to forget.

“I still can’t believe that I survived it,” she said.

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