Abstract Objective: To evaluate the concordance of the risk of neonatal respiratory morbidity (NRM) assessed by quantitative ultrasound lung texture analysis (QuantusFLM®) in fetuses of twin pregnancies. Methods : Prospective study conducted in twin pregnancies. Fetal ultrasound lung images were obtained at 26.0–38.6 weeks of gestation. Categorical (high or low) and continuous results of the risk of NRM were compared between twins. Results Fetal ultrasound lung images from 131 pairs of twins were included. The images were classified into three gestational age ranges: Group 1: 26.0 to 29.6 weeks (29.8%); Group 2: 30.0 to 33.6 weeks (37.4%) and Group 3: 34.0 to 38.6 weeks (32.8%). Concordance was good in Groups 1 and 3 and moderate in Group 2. In Groups 2 and 3 at least one fetus presented high-risk results in 26.5 % and 11.6% of twin pairs, respectively. Only gestational age <32 weeks, gestational diabetes mellitus and in vitro fertilization were associated with a high risk of NRM in Group 2. Conclusions There was good concordance of the risk of NRM between twins <30.0 weeks and >34.0 weeks. From 30.0 to 33.6 weeks 26.5% of the twin pairs had discordant results, with moderate concordance of the risk of NRM.