A recent Canadian study has brought to light the heightened risks faced by women who carry pregnancies as gestational surrogates. These women, often referred to as gestational carriers, experience significantly higher rates of pregnancy-related complications compared to women who carry their own pregnancies, either naturally or with the aid of fertility treatments like in vitro fertilisation (IVF). The findings from this study, published in the *Annals of Internal Medicine*, call for greater awareness, caution, and tailored medical care for surrogates to mitigate potential complications during pregnancy and childbirth.
Elevated Risks for Gestational Carriers
The study reveals that gestational carriers are at an increased risk of experiencing severe maternal morbidity, hypertensive disorders, and postpartum haemorrhage. These complications are not only more frequent but also more severe in surrogates compared to women who conceive naturally or through IVF. According to the research, surrogates face a 7.8% risk of severe maternal morbidity, which is more than three times higher than for women who conceive naturally. Additionally, the risk for surrogates is nearly double that of women who undergo IVF treatments.
The most common complications reported among surrogates include severe postpartum haemorrhage (excessive bleeding after delivery), preeclampsia (a condition marked by high blood pressure during pregnancy), and puerperal sepsis (a life-threatening infection after childbirth). These complications underscore the need for rigorous medical supervision throughout the surrogacy journey.
Data and Demographics: Understanding the Risk Factors
The study, conducted by researchers from McGill University, analysed over a decade's worth of data from the Better Outcomes Registry & Network (BORN) Ontario database, which records more than 99% of births in Ontario, Canada. Of the 863,017 singleton births examined in the study, 806 were pregnancies carried by surrogates.
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One of the significant findings is that gestational carriers tend to come from different demographic backgrounds compared to women who conceive naturally or via IVF. Surrogates are generally older, more likely to have given birth previously, and often live in lower-income areas. They also have higher rates of preexisting health conditions such as obesity and chronic hypertension. Interestingly, surrogates are less likely to smoke compared to women who conceive naturally, although these trends vary slightly when compared to those who undergo IVF.
Despite adjusting for these demographic and health factors, the study found that the elevated risk of severe maternal morbidity and preterm births still persisted for gestational carriers. This suggests that the risks associated with surrogacy may stem from factors beyond individual health conditions or socioeconomic status.
Impact on Neonatal Health
In addition to maternal complications, the study also uncovered a slight increase in neonatal risks for babies born to surrogates. Specifically, these pregnancies had a higher likelihood of preterm births compared to those conceived without the use of fertility assistance. While the exact reasons for this increase remain unclear, the data points to the need for close monitoring of both the surrogate and the baby throughout the pregnancy.
Calls for Comprehensive Care and Further Research
Given the rising popularity of surrogacy as a family-building option worldwide, these findings are particularly timely. The researchers stress the importance of careful selection and preparation of gestational carriers to minimise the risk of complications. The study emphasises the need for individualised pregnancy care plans tailored to surrogates' unique health profiles and risks. This could include more frequent monitoring for early signs of preeclampsia, targeted interventions to prevent postpartum haemorrhage, and enhanced support during the postpartum period.
Moreover, the study's authors call for further research to better understand the underlying mechanisms contributing to the increased risks observed in gestational carriers. This includes exploring the biological, psychological, and social factors that may play a role in these complications. A deeper understanding could lead to more effective strategies for reducing the risks and improving outcomes for both surrogates and the babies they carry.
Bottomline
The findings of this study highlight the complex medical challenges faced by gestational carriers, a group that is often overlooked in discussions about pregnancy risks. As the demand for surrogacy continues to grow, ensuring the safety and well-being of these women is crucial. By providing comprehensive and specialized care, healthcare providers can help mitigate the risks and ensure healthier outcomes for both surrogates and their babies.