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1. Surrogates face high risk of pregnancy and postpartum complications
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A large Canadian cohort study found that 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. 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 is published in Annals of Internal Medicine.
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.
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, gestational carriers continued to have a higher risk for severe maternal morbidity and preterm birth. Further studies are needed to understand potential mechanisms.
Expert Reaction
These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.
Professor Jackie Leach Scully is Professor of Bioethics at the University of New South Wales
As with any scientific report, it’s essential to bear in mind the limitations of this research, some of which are mentioned in the paper itself. Although the overall sample size was large, the subgroup of gestational carriers was small, and that may affect the results.
It’s important to be cautious before drawing general conclusions, particularly since we know that many women who have been gestational carriers or surrogates, have had healthy babies and gone through pregnancy with no health issues themselves.
Nevertheless, what this paper does highlight is that we actually know relatively little about the particular risks of harm to the woman who acts as surrogate, or the baby, in surrogacy. As the authors point out, while a gestational carrier should ideally be healthy and at low risk of complications, this is not always what happens in practice.
This raises some ethical questions, first of all about the potential exploitation of women who act as gestational carriers and who effectively bear the risks of pregnancy on behalf of someone else.
Second, the scarcity of accurate data on the risks and outcomes of surrogate pregnancies must really make us ask how seriously the health of women, as opposed to the health of the foetus or baby, is taken.
The neglect of women’s health in the history of medicine is well recognised, and may be exacerbated in the situation of surrogacy, where the gestational carrier’s role is socially obscured.
A/Professor Kuldip Sidhu is co-founder and director, CK Cell Technologies and Conjoint with University of New South Wales Medicine.
Gestational (surrogate) pregnancy is defined as the practice of bearing and carrying a child to term for couples or individuals who cannot conceive or carry a child themselves. This is generally carried out with the intended mother’s egg or a donor egg which is not from the surrogate. Surrogacy is on the rise globally due to the rise in infertility rates, renewed social acceptance and the advancing medical technology.
This cohort study by authors reporting severe maternal and neonatal morbidity with surrogacy is therefore very timely. However, the data and conclusion drawn with this study are not very surprising given the fact there are some limitations in this study, such as the lack of sociodemographic review about surrogates and their small sample size.
Also, understandably, surrogacy always runs the associated risk of carrying a non-autologous embryo. However, no fatality is reported with surrogacy in this study. Although both maternal and foetal complications are reported to be significantly higher in surrogacy than normal or IVF pregnancy, these figures are not alarming. Surrogacy is going to stay and will be safer with advancements in technology in the future.
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