Surrogates face a higher risk of pregnancy and postpartum complications compared to women who conceive naturally or through assistance, a recent study revealed.

A study published in the Annals of Internal Medicine investigated the health implications of three different types of pregnancy: unassisted pregnancy, in vitro fertilization, and gestational carriers.

The results revealed that surrogates are at a higher risk of severe postpartum hemorrhage, hypertension, and preeclampsia. Compared to those who conceive naturally or with IVF, they are also at a higher risk of preterm birth. However, evidence of severe neonatal morbidity was less clear. Neonatal morbidity refers to medical conditions that cause postdelivery inpatient hospital readmission, observational stays, or mortality within the first 28 days of life.

"The study was prompted by an increase in the use of gestational carriers worldwide and a lack of information about the impact of this reproductive modality on pregnancy outcomes, for the gestational carrier and the offspring," said lead author Dr. Maria Velez in a news release.

The researchers analyzed 863,017 births in Ontario, Canada, between 2012 and 2021, focusing on pregnancies that occurred without assistance, through IVF, and using gestational carriers. They looked at a wide range of health outcomes, including severe maternal and neonatal complications, preeclampsia, cesarean delivery, preterm births, and postpartum hemorrhage.

The results suggest that the risk of severe maternal morbidity was 2% for 2% for the unassisted group, 4% for the IVF group, and 8% for the gestational carriage group. When analyzing the risk of different morbidities, the gestational carriage group showed a higher risk for hypertensive disorders and postpartum hemorrhage.

"Clinicians involved in the care of individuals and couples who need a gestational carrier to build their family should counsel their patients and the gestational carriers about the potential risks during pregnancy and early postpartum. There are guidelines about the eligibility criteria to minimize the risk of pregnancy complications among gestational carriers. However, these guidelines are not always strictly followed," she added.

The study has certain limitations. It has not explored why parents opted for gestational carriers, the motivations of surrogates who chose to become carriers, or the sources of egg and sperm donors. Additionally, the specific type of IVF used was also not considered. These factors may have a significant say in understanding the risks associated with surrogacy.

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