Surrogacy, often seen as a pathway to parenthood for individuals or couples who cannot conceive, comes with hidden dangers that have only recently been brought to light. A new study conducted by McGill University has revealed that surrogate mothers, or gestational carriers, face significantly higher risks of severe pregnancy complications compared to women carrying their own pregnancies. These findings highlight the need for targeted healthcare strategies to protect the health and well-being of surrogates.
What Is Surrogacy?
Surrogacy involves a woman, known as a gestational carrier, who agrees to carry and give birth to a baby for another person or couple. The baby is conceived using either the intended parents’ or donors’ eggs and sperm, often through in vitro fertilization (IVF). Although surrogacy provides a solution for many who are unable to have children, it is not without risks for the gestational carrier.
Health Risks Associated with Surrogacy
The McGill University study, published in the Annals of Internal Medicine on September 24, 2024, examined over 10 years of data from the Better Outcomes Registry & Network (BORN) Ontario database. This extensive study analyzed health outcomes for both surrogates and women who conceived naturally or through fertility treatments. The results are concerning:
- Severe Maternal Morbidity: Surrogates were found to have a 7.8% risk of experiencing severe maternal morbidity (SMM), more than three times higher than women who conceived naturally and nearly twice as high as those who conceived through IVF.
- Postpartum Hemorrhage: Surrogates also had higher rates of severe postpartum hemorrhage, a condition where a woman experiences excessive bleeding after childbirth, which can be life-threatening.
- Hypertensive Disorders: The study identified a higher occurrence of hypertensive disorders during pregnancy, such as preeclampsia, in surrogates compared to other women.
Key Complications Surrogates Face
The study highlighted several key health risks for gestational carriers:
- Severe Postpartum Hemorrhage: This excessive bleeding after childbirth was one of the most common complications for surrogates.
- Severe Preeclampsia: A serious pregnancy complication characterized by high blood pressure that can damage other organs, often leading to preterm birth.
- Puerperal Sepsis: A life-threatening infection that can occur after childbirth, also more common among surrogates than among women who carried their own pregnancies.
These findings suggest that gestational carriers need specialized care and medical monitoring throughout the pregnancy and postpartum period to mitigate these risks.
Understanding the Study and Its Findings
The research team analyzed data from 863,017 singleton births, of which 806 were from gestational carriers. The study found that gestational carriers not only had a higher risk of severe maternal morbidity but also faced a slightly increased risk of severe neonatal morbidity, such as preterm birth. This suggests that the health risks of surrogacy extend beyond just the surrogate and may also affect the baby.
Demographics of Gestational Carriers
The study also looked at demographic and lifestyle factors that may influence the health risks associated with surrogacy. Key findings include:
- Previous Pregnancies: Surrogates were more likely to have previously given birth, potentially contributing to their higher risk for complications.
- Socioeconomic Factors: Gestational carriers were more likely to live in lower-income areas and have higher rates of obesity and chronic hypertension.
- Age and Lifestyle: Surrogates were generally older than women who conceived naturally but were less likely to smoke.
Even after adjusting for these factors, the study concluded that surrogates continued to face elevated health risks.
Why Are Surrogates at Higher Risk?
While the study does not provide definitive answers as to why surrogates are at higher risk, several factors may contribute:
- Fertility Treatments: Surrogates often undergo fertility treatments, such as IVF, which can increase the risk of complications like preeclampsia and postpartum hemorrhage.
- Multiple Pregnancies: Many surrogates have already had children, which may put additional strain on their bodies during future pregnancies.
- Older Age: Surrogates tend to be older than the average woman having her first child, which is a known risk factor for pregnancy complications.
The Need for Targeted Healthcare for Surrogates
Given the findings of this study, there is a clear need for better healthcare strategies tailored specifically for surrogates. The researchers emphasize that judicious selection of surrogates is crucial, along with developing personalized pregnancy care plans that address their unique needs and risks. Here’s what can be done:
- Enhanced Medical Screening: Potential surrogates should undergo thorough health screenings to ensure they are physically capable of carrying a pregnancy without undue risk.
- Specialized Pregnancy Care: Surrogates should receive more intensive medical monitoring throughout pregnancy, including frequent checkups to detect early signs of complications.
- Postpartum Support: Care does not end after childbirth. Surrogates may require extended medical attention and support during the postpartum period to recover safely.
Conclusion
Surrogacy offers a path to parenthood for many, but it comes with significant health risks for gestational carriers. The McGill University study provides vital insights into the challenges surrogates face, particularly the increased risks of severe maternal morbidity, hypertensive disorders, and postpartum hemorrhage. These findings highlight the importance of developing targeted healthcare strategies to ensure the safety and well-being of surrogate mothers.
As surrogacy continues to be a growing option for families, it is essential to prioritize the health of those who make this journey possible.
References
Velez, M. P., Ivanova, M., Shellenberger, J., Pudwell, J., & Ray, J. G. (2024). Severe Maternal and Neonatal Morbidity Among Gestational Carriers: A cohort Study. Annals of Internal Medicine. DOI: 10.7326/M24-0417.