Long-term Canadian study: Surrogates have 3x severe illness rate compared to natural pregnancies

A study published last week in the Annals of Internal Medicine pointed out a definite difference in health risks posed for surrogates compared to women who become pregnant traditionally and through IVF.

The cohort study, funded by the Canadian Institutes of Health Research, was set in Ontario, Canada, and spanned nearly a decade — from 2012 to 2021. Researchers evaluated 863,017 singleton births from 20 weeks’ gestation and onward. Of these participants, 97.6% (846,124) resulted from unassisted conception, 1.8% (16,087) through IVF, and 0.1% (806) by gestational carriage or surrogacy. The goal was to measure the rate of severe maternal morbidity and severe neonatal morbidity — or the severe illness/disease rate among the participants. Secondary measurements included hypertensive pregnancy risk, cesarean rates, prematurity, and postpartum hemorrhage. 

Findings revealed that the severe maternal morbidity (“a composite outcome measure that indicates serious, potentially life-threatening maternal health problems”) rate was much higher among the gestational carrier group when compared to the unassisted conception and IVF groups, although the IVF group was also slightly higher than the unassisted conception group. Severe maternal morbidity (SMM) rates recorded in each group was 2.3% for unassisted conception, 4.3% for IVF (nearly twice as high as unassisted), and 7.8% for gestational carriage (surrogacy).

That makes the severe illness and disease rate of surrogates over three times that of women who become pregnant naturally.

The researchers additionally noted that “hypertensive disorders, postpartum hemorrhage, and preterm birth at less than 37 weeks were also significantly higher contrasting gestational carriers to either comparison group.”

READ: Surrogacy is riskier for both women and babies than most people realize

The study’s lead author, Dr. Maria Velez, who is now a professor at McGill University and a scientist at the Research Institute of the McGill University Health Center, hypothesized, “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.”

The study did have limitations, however, including a lack of information about how surrogates were chosen, the health history of the egg and sperm donors, and a lack of information on severe neonatal morbidity. 

According to an interview conducted by Medical Xpress, Dr. Velez stated, “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 for the offspring.” 

The Center for Bioethics and Culture Network conducted its own research on this topic in 2022. It showed that surrogates are more likely to have high-risk pregnancies than non-surrogates, are three times more likely to have cesarean sections, more likely to have more premature deliveries, and are significantly more likely to experience postpartum depression than non-surrogate mothers. 

The risks of surrogacy are often framed to potential surrogates as “worth the reward.” American Surrogacy presents the risks of IVF drugs and surrogacy in general as a necessary struggle to help other families achieve pregnancy, although they do acknowledge there is some “emotional risk” when it comes to being a surrogate.

These new study results show — at the very least — a need for further study regarding why the morbidity rate is significantly higher among surrogates, and education to better convey these risks and dangers to unsuspecting women considering surrogacy. The practice, while presented as a form of altruism, puts women at risk, and treats both them and the children they carry as commodities.

Editor’s Note, 10/2/24: This article originally conflated maternal/neonatal morbidity with mortality. This has been corrected. We regret the error.

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