Objective — to assess the role of polymorphic markers for the genes determining angiogenesis and vascular tone in women with monochorionic multiple pregnancy complicated by feto-fetal transfusion syndrome. Subject and methods. The investigation enrolled patients with monochorionic diamniotic twins at 16—22 weeks’ gestation, who were divided into 2 groups. Group 1 included 21 pregnant women diagnosed with feto-fetal transfusion syndrome (a study group); Group 2 comprised 43 pregnant women without feto-fetal transfusion syndrome (a comparison group). Results. VEGF-A 936 C>T gene polymorphisms were ascertained to be the most significant genetic predictors associated with a high probability of the development of feto-fetal transfusion syndrome in pregnant women with monochorionic placentation. This allows these predictors to be used to form high-risk groups for timely diagnosis and treatment. Conclusion. An association between VEGF-A C936T gene polymorphism and a risk for feto-fetal transfusion syndrome has been established, which permits the polymorphic VEGF-A 936T allele to be regarded as a new genetic marker for feto-fetal transfusion syndrome. Our findings need to be further investigated in other population samples and to be comparatively analyzed with the data of other investigators. In addition, a more complete understanding of the molecular mechanisms involving the VEGF-A gene in the pathogenesis of feto-fetal transfusion syndrome in monochorionic multiple pregnancy requires additional epigenetic studies of the regulation of its expression.