Surrogates more likely to have hypertension and postpartum haemorrhage

Surrogates experience higher levels of complications during and after pregnancy compared to other IVF patients, a non-peer reviewed cohort study in Canada has shown. 

The study of 937,938 singleton births, including 956 women acting as surrogates for intended parents, found that these women were more likely to be older, have had children, reside in low-income areas and have chronic hypertension when compared to other women in the cohort. Authors from Canada presented the results at the 40th annual meeting of the European Society of Human Reproduction and Embryology.

Dr Raj Mathur a consultant gynaecologist and former chair of the British Fertility Society who was not involved in the research told BioNews: 'This study shows that gestational surrogates are at increased risk of serious complications in pregnancy. This highlights the importance of careful screening and counselling of surrogates. Surrogacy organisations should take on board this need and ensure that they have criteria to ensure that women at increased risk of complications such as high blood pressure are not encouraged to act as surrogates.'

Surrogates were found to have a 14.9 percent risk of hypertension and postpartum haemorrhage, compared to an 11 percent or 12 percent risk, respectively, for women who have a baby following IVF. Women who conceived naturally experienced a six percent risk of postpartum haemorrhage, and seven percent risk of hypertension. The cohort was followed between 20 weeks' gestation and 42 days after the delivery. 

One in 14 surrogates experienced severe health conditions linked to their pregnancy and birth compared to one in 22 women giving birth following IVF, and one in 42 women who conceived naturally. There was no difference in the rate of poor outcomes for babies up to 28 days old, born to women following IVF or natural conception and those born to surrogates. 

Authors said that the results could reflect that surrogates are likely to have poorer overall health before pregnancy, despite there being clear calls for only women with 'favourable characteristics for a healthy pregnancy' to be selected for surrogacy. 

'Gestational carriers were also less likely to be in the highest income bracket, and we know that lower socioeconomic status is associated with higher serious maternal morbidity rates. However, sociodemographic characteristics were accounted for in the analysis, and the results were similar, which suggest potential different mechanisms,' said Dr Maria Velez, study supervisor and senior author. 

Considering that surrogates were more likely to have had previous pregnancies and be older it was important to 'ensure that any woman intending to be a surrogate is both medically assessed as fit for pregnancy and given the opportunity to have implications counselling where all risks, including health risks, are made known to her prior to trying to conceive. If she knows and understands these risks and continues the surrogacy journey, her decision should be respected,' Kirsty Horsey, professor in law at Kent University, who was not involved in the study, told BioNews.