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

  • Assisted Reproduction Technologies
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Abstract

Purpose

We sought to characterize severe obstetric morbidity among women who are gestational carriers compared to other patients.

Methods

This was a population-based study comparing gestational carrier pregnancies to non-surrogate pregnancies (non-surrogate IVF pregnancies, all non-gestational carrier pregnancies, and a cohort of matched controls) delivering in Utah between 2009 and 2018, using birth certificate data. Our primary outcome was a composite of severe morbidity, including death, ICU admission, eclampsia, HELLP syndrome, transfusion, and unplanned hysterectomy. Our secondary outcomes were cesarean delivery (CD) and hypertensive disorders of pregnancy.

Results

During the study period, 361 gestational carrier pregnancies and 509,015 other pregnancies resulted in live births. Severe morbidity was less common among gestational carrier pregnancies than IVF pregnancies (1.7% versus 5.5%, odds ratio [OR] 0.29, 95% confidence interval [CI] 0.12–0.70), but was not different when compared to all other pregnancies (1.0%, OR 1.61, 95% CI 0.72–3.60), or a cohort of matched controls (1.0%, OR 1.37, 95% CI 0.55–3.40). CD was less common among gestational carrier pregnancies than IVF pregnancies, but not different than all other pregnancies or matched controls. While frequency of hypertensive disorders of pregnancy was lower among gestational carrier pregnancies than IVF pregnancies, it was higher than all other women who delivered and comparable to matched controls.

Conclusion

Severe obstetric morbidity is uncommon among gestational carrier pregnancies. Women who are gestational carriers are at lower risk of morbidity and CD than others who conceive through IVF and do not appear to be at increased risk compared to matched controls.

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Data availability

With the approval of the State of Utah Department of Health Office of Vital Records and Statistics, we will provide our data if requested.

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Acknowledgments

The study team would like to thank Ms. Yanling Shi with the Utah Department of Health Office of Vital Records and Statistics for her help providing and interpreting birth certificate data.

Author information

Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 550 16th St, San Francisco, CA, 94158, USA

    Kate Swanson & Miriam Kuppermann

  2. Division of Medical Genetics, Department of Pediatrics, University of California San Francisco, 550 16th St, San Francisco, CA, 94158, USA

    Kate Swanson

  3. University of Utah Center for Reproductive Medicine, 675 Arapeen Way, Salt Lake City, UT, 84108, USA

    Joseph M. Letourneau

  4. Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA

    Miriam Kuppermann

  5. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Utah Health, 50 N Medical Dr, Salt Lake City, UT, 84132, USA

    Brett D. Einerson

Authors
  1. Kate Swanson
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  2. Joseph M. Letourneau
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  3. Miriam Kuppermann
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  4. Brett D. Einerson
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Contributions

All authors contributed to the study conception and design. Data analysis was performed by the first author. The first draft of the manuscript was written by the first author. All authors read and approved the final manuscript prior to submission.

Corresponding author

Correspondence to Kate Swanson.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interests.

Ethics approval

This study was approved by the State of Utah Department of Health Office of Vital Records and Statistics.

Consent to participate

As only deidentified, publicly available birth certificate data was utilized, no consent to participate was obtained.

Consent for publication

As only deidentified, publicly available birth certificate data was utilized, no consent for publication was obtained.

Code availability

All statistical analysis was performed using Stata version 15.1 (StataCorp LLC, College Station, TX).

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Swanson, K., Letourneau, J.M., Kuppermann, M. et al. Obstetric morbidity in gestational carrier pregnancies: a population-based study. J Assist Reprod Genet 38, 177–183 (2021). https://doi.org/10.1007/s10815-020-02000-4

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  • DOI: https://doi.org/10.1007/s10815-020-02000-4

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