Obstetric morbidity in gestational carrier pregnancies: a population-based study

Area of Science:

• Reproductive Medicine and Obstetrics
• Maternal-Fetal Medicine
• Public Health Epidemiology

Background:

• Gestational carriers (GCs) undergo assisted reproductive technologies (ART) to carry pregnancies for others.
• Understanding severe obstetric morbidity in GCs is crucial for patient safety and counseling.
• Comparative data on GC outcomes versus other pregnancy types are limited.

Purpose of the Study:

• To characterize and compare severe obstetric morbidity in gestational carrier pregnancies versus other patient groups.
• To assess risks of cesarean delivery and hypertensive disorders of pregnancy in GCs.

Main Methods:

• Population-based study using Utah birth certificate data (2009-2018).
• Compared 361 GC pregnancies with non-surrogate IVF pregnancies, all non-GC pregnancies, and matched controls.
• Primary outcome: composite of severe morbidity (death, ICU admission, eclampsia, HELLP, transfusion, hysterectomy).

Main Results:

• Severe morbidity was lower in GC pregnancies (1.7%) vs. IVF pregnancies (5.5%).
• No significant difference in severe morbidity for GCs vs. all other pregnancies (1.0%) or matched controls (1.0%).
• Cesarean delivery rates were lower for GCs vs. IVF, but comparable to other groups; hypertensive disorders were lower vs. IVF but comparable to controls.

Conclusions:

• Severe obstetric morbidity is infrequent in gestational carrier pregnancies.
• Gestational carriers exhibit lower risks of morbidity and cesarean delivery compared to other IVF conceptions.
• Gestational carriers do not appear to have increased obstetric risks compared to matched controls.