Surrogate Mothers Face Increased Risks of Hypertension, Bleeding and Preterm Birth: Study

More research is needed to understand why surrogate mothers face higher risks of pregnancy and birth related complications.

Women who give birth as surrogates, instead of via natural conception or in vitro fertilization (IVF), appear to face greater risks of suffering from complications during pregnancy and delivery, including uncontrollable bleeding and premature birth, which could lead to serious risks for the mother or baby.

Surrogate pregnancies are becoming increasingly more common in the U.S. and other developed countries around the world. In a surrogate pregnancy, a woman, or surrogate, agrees to carry a fetus and give birth for another woman. Sometimes, this is because of infertility or other difficulties the woman may face in becoming pregnant.

There are different arrangements for surrogate pregnancies. In some cases, the surrogate mother is impregnated with her own egg fertilized by the father, giving the child up to the couple after birth. This is often done for women who are infertile and can’t conceive.

In other cases, the parents donate both the egg and the sperm, and the surrogate mother carries the pregnancy to term and gives up the child to the parents after birth. This is often done because of risks to the mother’s health if she were to carry the pregnancy.

In the findings of a new study published in the Annals of Internal Medicine on September 24, researchers warn that surrogate mothers may face two to three times higher risks of suffering from serious complications than other mothers, including preeclampsia, postpartum hemorrhage and preterm birth. All of which can lead to severe injury or death for the mother or baby.

In the study, researchers from Queen’s University Kingston in Ontario, Canada, led by Dr. Maria P. Velez, reviewed birth data for more than 846,000 infants born at more than 20 weeks of pregnancy from 2012 to 2021, focusing on surrogate mothers who became pregnant using both donor eggs and sperm.

The majority of pregnancies in the sample group, 97%, were conceived unassisted. Two percent, or about 16,000 pregnancies, were conceived using IVF, and 0.1% or 806 pregnancies were conceived using surrogates.

Overall, women who conceived and served as surrogates faced a higher rate of complications. The rate of complications was nearly 8% among surrogates, but 2% among those who conceived unassisted, and 4% for those who conceived using IVF.

The risk of complications was three times as high for surrogacy compared to typical unassisted conception. It was nearly twice as high for surrogacy compared to using IVF.

Women who were surrogates faced a higher risk of health problems, including uncontrollable bleeding and high blood pressure, which can lead to death, life-threatening infections like sepsis, and giving birth prematurely.

The researchers were unsure why surrogacy affects pregnant women differently compared to unassisted conception. They hypothesized that pregnancy may affect the immune system. A surrogate pregnancy could lead to an altered immune system that is overreactive, or it could cause complications or an imbalance in the body due to the different immune systems between the surrogate and the fetus.

The findings may also be related to prior health conditions of the surrogate mother that weren’t accounted for in the study.

Velez’s team concluded that more research is needed to fully uncover the reasons why surrogacy may be more dangerous for women compared to unassisted conception. They also recommended doctors work to develop pregnancy and delivery care plans to ensure the health of expecting mothers and the fetus are monitored closely.

Pregnancy Hypertension Concerns

Surrogate mothers are not the only pregnant women at risk from hypertension, preeclampsia and other serious conditions. Hypertensive disorders are one of the leading causes of pregnancy-related deaths in the U.S., and many of these deaths are preventable.

Earlier this year, researchers from Stanford University indicated chronic hypertension during pregnancy has doubled in recent years, and only about half of women are being prescribed hypertension medication to help reduce the risks.

In addition, a federal task force recently called for updated screening guidelines and for more research into hypertension prevention methods, especially since the United States has the highest maternal death rate in the world among wealthy nations.