Pregnancy
Surrogacy associated with higher risk of severe pregnancy outcomes

People who are gestational carriers – or “surrogates” – may have a higher risk of severe complications during pregnancy and early postpartum, hypertension in pregnancy, and postpartum haemorrhage, compared to people who conceive without assistance or with IVF.
Gestational carriers carry and give birth to children for couples or individuals who are otherwise unable to carry a pregnancy. Little is known about whether gestational carriers and babies are at a higher risk for severe health outcomes, both during pregnancy and following birth.
This study, carried out by ICES and Queen’s University, is one of the first large population-based studies to analyse linked health datasets comparing health outcomes for three different types of conception: unassisted, in vitro fertilization (IVF), and gestational carriage.
“The study was prompted by an increased 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 the offspring,” says lead author Dr. Maria Velez, an adjunct scientist at ICES and at the time of this study, an associate professor in the department of Obstetrics and Gynaecology at Queen’s University.
Velez is currently an associate professor and a clinician scientist at McGill University and the Research Institute of the McGill University Health Centre (RI-MUHC)
The study included 863,017 singleton births at more than 20 weeks’ gestation in Ontario, Canada, between 2012 and 2021. The groups included 846,124 who were conceived without assistance, 16,087 by IVF, and 806 using gestational carriers.
The researchers analysed severe maternal morbidity (SMM) and severe neonatal morbidity (SNM), which combine many different health indicators for both birthing people and babies. They also assessed hypertensive disorders (such as pre-eclampsia), caesarean delivery, preterm birth, and postpartum hemorrhage.
Key findings from the study include:
- The risk of SMM was 2% for the unassisted group, 4 per cent for the IVF group and 8 per cent for the gestational carriage group.
- The gestational carriage group also had a higher risk for hypertensive disorders and postpartum haemorrhage when analysed separately from SMM.
- Although gestational carriage was associated with preterm birth (less than 37 weeks’ gestation), there was less clear evidence of a higher risk of SNM.
One limitation of the study was that there was a lack of information about why gestational carriage was chosen by the intended parents, egg and sperm donor sources, the type of IVF used, and reasons why people chose to become gestational carriers. Future research could help to assess whether any of these factors would impact the health outcomes of the pregnant person or the baby.
“Clinicians involved in the care of individuals and couples who need a gestational carrier to build their family should counsel their patients and the gestational carriers about the potential risk during pregnancy and early postpartum,” says Velez.
“There are guidelines about the eligibility criteria to minimize the risk of pregnancy complications among gestational carriers,” she adds. “However, these guidelines are not always strictly followed.”
Pregnancy
UK research paves way for new preeclampsia therapies

A preeclampsia study has found unusual cell activity in mothers and babies that could reveal new targets for treatment.
The condition affects 2 to 4 per cent of pregnancies worldwide and is a leading cause of maternal and foetal mortality.
There is currently no cure, and severe cases can put both the mother and baby at risk.
Scientists from UCL and University College London Hospitals found that stressed placental cells, poorly functioning blood vessels and an overactive immune response all contribute to the condition.
Preeclampsia causes high blood pressure during pregnancy. It can affect blood flow to the baby and cause symptoms such as swelling, headaches, blurred vision and pain under the ribs.
Without treatment, it can damage the mother’s health, slow the baby’s growth and, in severe cases, become life-threatening.
Previous research has focused only on the placenta, the organ that develops during pregnancy to support the baby’s growth, rather than the tissues around it.
The researchers said the findings could reveal new therapeutic targets, which are biological processes that future treatments could be designed to alter.
Senior author professor Sara Hillman, of the UCL EGA Institute for Women’s Health, said: “We studied individual cells from both the mother and the baby to see how their activity changes in healthy pregnancies compared with preeclampsia.
“This helped us to confirm some changes already suspected in the condition and also discover new ones.”
The team studied 20 pregnant women recruited at UCLH, including 10 with severe preeclampsia and 10 without the condition.
They used genomic testing to examine individual cells in the placenta and other tissues where cells from the developing baby and mother come into contact.
Genomic testing examines genetic information to help researchers understand how cells behave and the roles they may play.
The other tissues studied were the myometrium, the muscular layer of the womb, and the chorioamniotic membranes, which surround the baby during pregnancy.
The team compared cells from healthy pregnancies and those affected by preeclampsia at different gestational ages, meaning different stages of pregnancy.
They used technology that can read the genetic information of thousands of individual cells at the same time, allowing them to see what each cell was doing and where it was located in the tissue.
In preeclamptic pregnancies where babies were born prematurely, before 37 weeks, during the third trimester, placental cells showed signs of stress and low oxygen levels.
The cells also did not use energy in the normal way.
Some cells responsible for reshaping the mother’s blood vessels were not working properly, the researchers found, which may affect blood flow to the baby.
There were also signs of an overactive immune response in the placenta, nearby tissues and the mother’s blood.
The researchers said this response, together with other stress molecules released by the placenta, helps explain why preeclampsia affects the whole body and can become serious.
They hope the findings will help researchers find treatments for the condition and potentially save lives.
Co-lead author Dr Yara Sanchez Corrales, of the UCL Great Ormond Street Institute of Child Health, said: “These findings point to specific biological processes that could be targeted with treatments. Acting early in pregnancy, especially in more severe early-onset cases, could help improve outcomes and reduce the high risks associated with severe preeclampsia.
“We hope that our findings may set us on the path to reducing premature births and fatalities associated with preeclampsia.”
Co-lead author Mr Theodoros Xenakis, of the UCL Great Ormond Street Institute of Child Health, said: “Future studies may provide an even clearer picture of the biological changes linked to the disease by including more participants and using even more precise methods.”
Pregnancy
Pregnancy complications may increase risk for artery disease, study finds

Pregnancy complications may increase women’s risk of peripheral artery disease later in life, new research suggests.
The study analysed data from more than two million women in Sweden who gave birth to single babies between 1973 and 2015.
Led by Casey Crump, the research examined the long-term risk of peripheral artery disease among women who experienced preterm delivery, pre-eclampsia, gestational diabetes or other adverse pregnancy outcomes.
Crump, professor in the department of family and community medicine at McGovern Medical School at UTHealth Houston, said: “Our prior work has already shown that adverse pregnancy outcomes are associated with long-term risks of heart disease, stroke, and heart failure.
“This study builds on that work by showing that these women have an increased risk of peripheral artery disease, an important but understudied cardiovascular condition.”
Peripheral artery disease is often a precursor to long-term cardiovascular complications, including stroke, ischaemic heart disease and premature death.
The condition affects millions of people worldwide and occurs when narrowed arteries reduce blood flow, most commonly to the legs and feet.
Ischaemic heart disease occurs when the heart does not receive enough blood and oxygen, usually because the arteries have narrowed.
Symptoms of peripheral artery disease can include leg pain, cramps while walking, numbness, cold feet and sores on the feet or legs that are slow to heal.
Crump said women who experience pregnancy complications have an important opportunity after giving birth to make plans with their primary care doctor to monitor long-term risks.
Women who have experienced complicated pregnancies should speak with their doctor about possible future cardiovascular health risks.
Checks for blood pressure, diabetes and cholesterol are important.
While the period after childbirth is an important time for women to monitor their health, Crump said it is never too late to lower the risk of peripheral artery disease.
He said: “Women with a history of adverse pregnancy outcomes who seem to be doing well may still have a higher risk that can emerge later in life.”
Crump also suggested preventive steps such as avoiding smoking, maintaining a healthy weight and following a healthy lifestyle.
He stressed the importance of long-term follow-up care and conversations with healthcare providers to help protect cardiovascular health later in life.
Insight
New pregnancy treatment shows promise for at-risk twins

A high-powered ultrasound treatment could help identical twins affected by a rare and serious condition during early pregnancy, an initial study suggests.
Twin-to-twin transfusion syndrome, or TTTS, causes uneven blood flow between identical twins who share a placenta.
The imbalance can leave one baby dangerously small and the other too large, putting both babies’ survival at risk.
Brioney Garrett’s daughters were in danger before doctors used the world-first treatment to seal the blood vessels causing the problem without an operation.
Nancy and Margo were born healthy and, now aged four, are due to start school.
Researchers from Queen Charlotte’s and Chelsea Hospital tested the non-invasive procedure in 10 women from the UK and elsewhere in Europe after scans detected TTTS during early pregnancy.
Five women needed further treatment, while 12 of the 20 babies survived following the procedure.
The researchers described having a treatment that did not require a needle or telescope to be inserted into the mother’s abdomen as “extremely exciting”.
However, they said larger studies involving more pregnant women were needed before the procedure could be offered more widely.
Garrett described her daughters as “my miracle twins”.
She said: “We were in a very dire situation and I don’t forget that.
“It stays with me always how things could have been. Every day I still count my blessings.”
TTTS affects between 10 and 15 per cent of identical twins who share a placenta, representing around 300 to 400 pregnancies in the UK each year.
The uneven blood flow causes excess fluid to build up around the larger recipient baby, while leaving dangerously little fluid around the smaller donor baby.
Treatment usually involves inserting a needle into the womb to drain some of the fluid or using a laser to seal the connecting blood vessels.
Garrett’s procedure took about 20 minutes. She lay flat while a specially designed machine directed high-powered ultrasound waves at small blood vessels in her placenta.
She said: “It was very quick and pretty painless.”
Christoph Lees, head of fetal medicine at Imperial College Healthcare NHS Trust and professor of obstetrics at Imperial College London, described the research as “very promising”.
He said: “If this could work in a fully-fledged study, it could give hope to a lot of women who otherwise might have to have quite invasive treatment.”
Ultrasound is commonly used during medical scans to produce images of the body, but this procedure uses much more focused waves.
Heat generated by the waves can seal blood vessels about 2mm in diameter and located around 5cm to 6cm beneath the skin.
The procedure blocked blood flow in 90 per cent of the vessels treated during the study, with no unwanted side-effects reported.
Twins Trust, which supported the study, said the approach could make a significant difference for families affected by TTTS.
Helen Peck, head of healthcare engagement and research, said: “Any procedure that is non-invasive and can potentially identify TTTS earlier and improve outcomes for our families with this life-threatening condition could be a turning point.”
Scans carried out weeks after Garrett’s procedure showed that blood flow between the babies had been rebalanced, although other problems developed during the pregnancy.
Garrett said Margo, who had too little fluid around her, “was in a much better position” and that “the strain on Nancy’s heart had eased”.
Nancy and Margo were born at nearly 34 weeks, weighing 3lb 7oz and 3lb 3oz respectively.
Garrett said: “They were both healthy, and Margo wasn’t as small as we worried she was going to be.”
The twins are due to start primary school in September.
Garrett said: “They’re funny, smart, energetic little girls that just fit right in with their age group.”
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