Research indicates that surrogates experience increased risks of severe health complications during and after pregnancy, including higher rates of severe maternal morbidity and postpartum hemorrhage, compared to traditional pregnancies.
Gestational carriers, or pregnancy surrogates, face a higher associated risk for severe maternal morbidity, hypertensive disorders of pregnancy, and postpartum hemorrhage compared with women who carry their own pregnancies with or without fertility assistance. These findings are based on a large Canadian cohort study.
According to the researchers, these findings suggest that a judicious selection of these carriers is warranted alongside the development of specific pregnancy care plans in this population. The study was published on September 24 in Annals of Internal Medicine.
Detailed Study From McGill University
Researchers from McGill University studied more than 10 years of data from the Better Outcomes Registry & Network (BORN) Ontario database, which represents more than 99% of births in Ontario, to determine the risk for complications before, during, and after childbirth among gestational carriers.
The study included 863,017 singleton births, 806 of which were from gestational carriers. The researchers found that the risk for severe maternal morbidity was 7.8% in gestational carriers, more than 3 times that of unassisted conception and nearly twice that of invitro fertilization (IVF) pregnancies.
The three most common morbidities were severe postpartum hemorrhage, severe preeclampsia, and puerperal sepsis. The risk for severe neonatal morbidity was also slightly higher among gestational carriers compared to unassisted conception, with preterm birth more likely among gestational carriers.
Demographics and Risk Factors Among Gestational Carriers
The authors noted that gestational carriers were more likely to have given birth previously, reside in a lower-income area, and have higher rates of obesity and chronic hypertension. They also were more likely than the unassisted conception group to be older and nonsmokers, with some opposite trends when gestational carriers were compared with IVF recipients.
However, after accounting for these factors, surrogates continued to have a higher risk for severe maternal morbidity and preterm birth. Further studies are needed to understand potential mechanisms.
For more on this research, see The Hidden Risks of Surrogacy: What New Research Reveals.
Reference: “Severe Maternal and Neonatal Morbidity Among Gestational Carriers: A cohort Study” by Maria P. Velez, MD, PhD; Marina Ivanova, BSc; Jonas Shellenberger, MSc; Jessica Pudwell, MSc, MPH and Joel G. Ray, MD, MSc, 24 September 2024, Annals of Internal Medicine.
DOI: 10.7326/M24-0417