Surrogacy linked to higher risk of pregnancy complications: study

The risk of complications is higher in gestational carriers or pregnancy surrogates compared with women who carry their own pregnancies with or without fertility assistance, reports a large Canadian cohort study.

Researchers from McGill University who conducted the study — involving 863,017 singleton births, 806 of which were from gestational carriers — recommend a judicious selection of gestational carriers, alongside the development of specific pregnancy care plans in this population.

Their analysis of more than 10 years of data from the Better Outcomes Registry & Network (BORN) Ontario database found the risk for severe maternal morbidity was 7.8% in gestational carriers, more than three times that of unassisted conception and nearly twice that of in vitro fertilisation (IVF) pregnancies. The findings have been published in Annals of Internal Medicine.

Three most common morbidities

The three most common morbidities were severe postpartum haemorrhage, severe pre-eclampsia 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 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 non-smokers, 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.

Ethical questions

Jackie Leach Scully, Professor of Bioethics at UNSW Sydney, said that as with any scientific report, it’s essential to bear in mind the limitations of this research. While the overall sample size was large, the subgroup of gestations carriers was small, Scully said, noting that it’s important to be cautious before drawing general conclusions — particularly since 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,” Scully said.

“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.”

Study limitations

Associate Professor Kuldip Sidhu, co-founder and Director of CK Cell Technologies and Conjoint with UNSW Medicine, said that with surrogacy on the rise globally, this research is 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,” Sidhu said.

“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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