In recent years, gestational surrogacy has gained more visibility as an option for families who are unable to carry a pregnancy. However, a new study presented at the ESHRE 40th Annual meeting in Amsterdam recently brings to light an important, often under-discussed aspect: gestational carriers face significantly higher maternal morbidity and pregnancy risks compared to other pregnant women.
Elevated Risks for Gestational Carriers
The population-based study analyzed 937,938 singleton births in Ontario, Canada between 2012 and 2021, comparing outcomes among unassisted conceptions, IVF conceptions, and gestational carriers. The article presents findings that suggest gestational carriers are at a heightened risk of complications such as gestational diabetes, preeclampsia, preterm delivery, and postpartum hemorrhage. The data is clear: the rates of maternal morbidity are higher in this group, with preeclampsia being a key concern. This finding is critical, as preeclampsia can have serious health consequences for both the mother and the baby if not properly managed.
The study shows that gestational carriers also face increased rates of cesarean sections compared to other women. The reasons for this aren’t entirely clear but could be linked to factors like the medical protocols involved in surrogacy or the management of the pregnancy in these unique circumstances.
What Drives These Risks?
One of the central questions the article explores is why gestational carriers experience higher risks. A key factor might be the role of assisted reproductive technologies (ART). Many gestational surrogacies involve the transfer of embryos that have been conceived through in vitro fertilization (IVF), which carries its own set of risks. Additionally, multiple embryo transfers, common in ART, can increase the likelihood of high-risk pregnancies.
Another layer to this is the hormonal and physical changes that occur during pregnancy. Surrogates often undergo rigorous medical treatments to prepare their bodies for pregnancy, and these interventions may contribute to the higher rates of complications, however they still face risks higher than women undergoing IVF with their own embryos.
Socioeconomic Factors and Surrogacy
Another dimension that adds complexity to the risks faced by gestational carriers is the socioeconomic background of many surrogates. Surrogates are more often not from the highest income bracket. This dynamic can also lead to disparities in access to quality healthcare, which may exacerbate their vulnerability to pregnancy complications. Economic pressures, combined with the medical and physical toll of surrogacy, create a unique challenge in managing their health throughout the process.
Implications for Gestational Surrogacy Practices
These findings underscore the need for careful consideration when it comes to the health and well-being of gestational carriers. For many, surrogacy is a life-changing opportunity to help others become parents, but it’s essential to recognize the health risks involved. Medical professionals, surrogacy agencies, and intended parents need to ensure that the surrogate’s health is a top priority, with comprehensive medical screening and support throughout the pregnancy.
Given the socioeconomic dynamics at play, there is also an ethical dimension to ensuring that surrogates are not taking on undue risks because of financial pressures. Proper compensation and healthcare access should be guaranteed, alongside protections that prevent exploitation of economically vulnerable women.
Looking Ahead
As gestational surrogacy continues to grow in popularity, more research is needed to fully understand the factors contributing to these elevated risks. In the meantime, open communication and thorough medical care are critical for safeguarding the health of gestational carriers, ensuring that this process can be as safe and positive as possible for everyone involved.
This article reminds us that while surrogacy offers incredible possibilities, it also requires a deep commitment to the health and safety of those who make it possible, especially those from more vulnerable socioeconomic backgrounds.
The study abstract will be published in Human Reproduction, one of the world’s leading reproductive medicine journals
Dr Marina OBGYN