Background: For singletons, the relationship between gestational hypertensive disease (GHD) and fetal growth anomalies has been established. However, the association between GHD and birthweight discordance in twin pregnancies is inclusive. Objective: To explore the association between GHD and birthweight discordance in twin pregnancies. Search strategy: PubMed, Embase, Web of Science and Cochrane Library were systematically searched from establishment until July 2021. Selection criteria: Studies reporting the risk of birthweight discordance in twin pregnancies complicated by GHD compared with those not were included. Data collection and analysis: Odds ratios (OR) and 95% confidence intervals (CI) were extracted. Study heterogeneity was evaluated by I2 index. Sub-group analyses and stratification were performed. Risk of bias was assessed with the Newcastle-Ottawa Scale. Main results: Ten studies (304181 twin pregnancies) were included. GHD (OR 1.65, 95% CI 1.41-1.94) was a risk factor for intertwin birthweight discordance [preeclampsia (OR 1.66, 95% CI 1.32-2.08); chronic hypertension (OR 1.59, 95% CI 1.46-1.73)]. No evident association was observed between gestational hypertension (GH) and intertwin birthweight discordance (OR 1.24, 95% CI 0.96-1.60). After stratification, birthweight discordance was related to GHD (OR 2.51, 95% CI 2.01-3.14), GH (OR 2.08, 95% CI 1.33-3.25) and preeclampsia (OR 2.74, 95% CI 2.09-3.61) in dichorionic pregnancies, but no longer associated with GHD and preeclampsia in monochorionic group. Conclusions: Twin gestations complicated with GHD, especially in DC pregnancies, were at significantly higher risk of birthweight discordance. Funding: Science and Technology Program of Nantong City (MS12020036). Keywords: gestational hypertensive disease, birthweight discordance, twin pregnancies, chorionicity, systematic review