Surrogates at Higher Risk of Complications From Pregnancy, Preterm Births

Surrogacy is becoming an increasingly popular method for starting (or expanding) a family. For some, because of infertility or medical issues, it is the only option for bringing a biological child into the world. For others, it’s a choice to avoid pregnancy. But in almost all cases, the procedure comes at a cost of over $100,000.
For the surrogate, the compensation averages around $50,000. But according to new research, it might not be worth the cost.
“Our study provides objective data on a potential higher risk of pregnancy complications for gestational carriers,” Maria Velez, the study’s first author and a professor of obstetrics and gynecology at Ontario’s Queen’s University, told Newsweek.
The research, published in the journal Annals of Internal Medicine, examined data from over 860,000 live births from across Ontario between 2012 and 2021, 806 of which were from surrogate carriers. The team found that the risk of severe maternal morbidity for surrogate carriers was 7.8 percent, more than three times that of mothers giving birth through unassisted conception and nearly twice that of mothers who got pregnant through in vitro fertilization.
The three most common morbidities were severe postpartum hemorrhage, severe preeclampsia and sepsis.
The risks were also higher for the baby, with slightly higher levels of severe neonatal morbidity among surrogate pregnancies and an increased risk of preterm births.
The researchers said that the surrogate carriers tended to have given birth previously, resided in lower-income areas and had higher rates of obesity and chronic hypertension. However, after accounting for these variables, the risks of severe maternal morbidity and preterm births were still higher among the surrogates.
So what might be driving these concerning statistics? “It could be from an immunological mechanism, the egg and sperm donors being new to the surrogate carrier, or prior health conditions of the surrogate carrier, some of which were not accounted for in our study,” Velez said.
More work needs to be done in this area to understand these mechanisms, as well as what the long-term health outcomes might be for surrogates and the children they carry.
It is also important to note that these findings were purely associative and that more work is needed to prove that surrogacy is actually causing these complications. Furthermore, the number of surrogates in the study is very small compared with the number of unassisted births, potentially raising issues for the statistical analysis. Even so, more education and research are needed into the risks of surrogacy.
“We hope that our findings will provide objective data for physicians, gestational carriers and [intended] parents to make an informed decision to proceed with this reproductive option,” Velez said. “The industry—or those involved in this type of reproductive option—wants to do its very best to ensure that the gestational carrier is healthy prior to the pregnancy and remains so during and soon after giving birth.”
She continued: “For some planning a family, a gestational carrier is the only option available, other than adoption. Our findings can inform future discussions about this type of reproductive option and guidelines that need to be followed to prevent pregnancy complications among gestational carriers.”
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Maria P. Velez, Marina Ivanova, Jonas Shellenberger, et al. Severe Maternal and Neonatal Morbidity Among Gestational Carriers: A Cohort Study. Annals of Internal Medicine (2024). doi:10.7326/M24-0417