A recent study presented at the ESHRE 40th Annual Meeting in Amsterdam underscores the elevated health risks faced by gestational carriers, commonly known as surrogates, compared to women who conceive naturally or through in vitro fertilization (IVF). Conducted in Ontario, Canada, the population-based study analyzed data from 937,938 singleton births between 2012 and 2021, focusing on outcomes across different conception methods including unassisted conceptions, IVF, and gestational carriers. The findings, published in Human Reproduction, highlight significant disparities in maternal morbidity rates among these groups.
Gestational carriers exhibited a notably higher severe maternal morbidity rate of 7.1%, compared to 2.4% in unassisted conceptions and 4.6% in IVF conceptions. Specifically, gestational carriers experienced increased incidences of postpartum hemorrhages and hypertensive disorders, critical complications during pregnancy. Postpartum hemorrhage rates were 13.9% among gestational carriers, significantly higher than the 5.7% in unassisted conceptions and 10.5% in IVF conceptions. Similarly, hypertensive disorders affected 13.9% of gestational carriers, compared to 6.6% in unassisted conceptions and 11.6% in IVF conceptions.
Marina Ivanova, study author from Queen’s University in Kingston, Canada, suggested several potential factors contributing to these heightened risks, including variances in baseline health or sociodemographic characteristics among gestational carriers, disparities in prenatal care and monitoring, the physiological and psychological impacts of carrying a pregnancy for someone else, and the effects of treatments used during IVF.
Dr. Maria Velez, study supervisor and senior author, added insights into socioeconomic factors influencing these outcomes. “Gestational carriers were less likely to be in the highest income bracket, a factor known to correlate with increased serious maternal morbidity rates. Despite adjustments for sociodemographic variables, the study’s findings suggest underlying mechanisms that warrant further investigation.”
The study defines gestational carriers as women who carry a genetically unrelated child for another person or couple, typically through IVF where the intended parent’s embryo is implanted into the carrier’s uterus. The utilization of gestational carriers has surged due to rising infertility rates, increasing numbers of male same-sex couples seeking parenthood, societal acceptance of diverse family structures, advancements in medical technology, and expanding fertility clinic services globally.
Despite the heightened maternal health risks associated with gestational carriers, the study found no significant difference in health outcomes among neonates up to 28 days old when compared to infants from unassisted or IVF conceptions. Severe health problems were reported in 6.5% of neonates born to gestational carriers, 6% from unassisted conceptions, and 9.1% from IVF conceptions.
Marina Ivanova commented on this unexpected finding, stating, “Despite the increased risks for gestational carriers, we observed no significant increase in severe neonatal morbidity compared to natural conceptions. This suggests that while gestational carriers face more complications, these do not necessarily lead to worse outcomes for newborns—a reassuring outcome.”
Professor Dr. Karen Sermon, Chair of ESHRE, emphasized the study’s implications for reproductive health and the necessity of ensuring optimal care standards for gestational carriers. “These results underscore the impact of socioeconomic factors on reproductive health and highlight the importance of providing comprehensive care to gestational carriers. It is reassuring—and intriguing—that children born via gestational carriers do not appear to be adversely affected by the higher pregnancy risks.”
The study concludes by calling for further research into the interplay between maternal and neonatal health outcomes in diverse conception methods, aiming to better understand and mitigate risks associated with gestational carriers while supporting safe and effective reproductive practices.
