New research presented at the ESHRE 40th Annual Meeting reveals that gestational carriers, commonly known as surrogates, face significantly elevated risks of severe maternal morbidity and adverse pregnancy outcomes compared to women conceiving naturally or through in vitro fertilization (IVF).
The population-based study examined 937,938 singleton births in Ontario, Canada, spanning from 2012 to 2021. It compared outcomes among unassisted conceptions, IVF conceptions, and pregnancies involving gestational carriers.
Key findings from the study highlighted substantial differences in maternal health outcomes across these conception methods. Gestational carriers exhibited a severe maternal morbidity rate of 7.1%, notably higher than rates observed in unassisted conceptions (2.4%) and IVF conceptions (4.6%). Specifically, gestational carriers experienced elevated rates of postpartum hemorrhages (13.9%), compared to 5.7% in unassisted conceptions and 10.5% in IVF conceptions. Similarly, hypertensive disorders affected gestational carriers at a rate of 13.9%, compared to 6.6% in unassisted conceptions and 11.6% in IVF conceptions.
Dr. Maria Velez, study supervisor and senior author, noted that despite the perception that gestational carriers are selected based on favorable health characteristics, the study cohort did not consistently reflect this assumption. Factors such as lower socioeconomic status among gestational carriers, which is associated with higher maternal morbidity rates, were considered in the analysis but did not fully explain the elevated risks observed.
Gestational carriers, defined as women carrying a genetically unrelated child for another individual or couple, typically undergo IVF to implant the intended parent’s embryo into their uterus. The rise in gestational carrier use is attributed to increasing infertility rates, societal acceptance of diverse family structures, and advancements in reproductive technologies.
Despite the heightened maternal risks, the study did not find significant differences in health outcomes for newborns up to 28 days old among gestational carriers, unassisted conceptions, and IVF conceptions. Serious health problems were present in 6.5%, 6%, and 9.1% of neonates, respectively.
Lead researcher Marina Ivanova highlighted the unexpected finding that while gestational carriers experience more complications, these do not necessarily translate into worse outcomes for newborns. This contrasts with findings in the general population, where severe maternal morbidity is linked to higher risks of severe neonatal morbidity, warranting further investigation into underlying mechanisms.
Professor Dr. Karen Sermon, Chair of ESHRE, emphasized the study’s implications for reproductive health, stressing the importance of providing gestational carriers with comprehensive care to mitigate risks. The findings, to be published in Human Reproduction, underscore the need for continued research and enhanced support for gestational carriers to ensure optimal outcomes for both mothers and babies.
