Surrogate pregnancy: an essential guide for clinicians

Abstract

The incidence of surrogacy is rising. Literature on associated obstetric risks is scarce and caution must be exercised when labelling surrogate pregnancies as low risk. Although obstetricians’ responsibilities lie with the surrogate mother, they must ensure her wishes do not conflict with the best interests of the baby. Prepregnancy counselling is the key to a successful surrogacy arrangement. Learning objectives: To gain an awareness of the different types of surrogacy. To understand the law surrounding surrogacy. To learn about antenatal, intrapartum and postpartum care in surrogacy. Ethical issues: When the surrogate mother's wishes and the interests of the child conflict, do obstetricians have the right to discuss this with the commissioning parents without her consent? When should obstetricians seek ethical and legal support? Please cite this article as: Bhatia K, Martindale EA, Rustamov O, Nysenbaum AM. Surrogate pregnancy: an essential guide for clinicians. The Obstetrician & Gynaecologist 2009;11:49–54.

Corrigendum

“…It has been brought to our attention that several sections of the following article were very similar to those in a previous publication . Although the previous publication was referenced at some points, it was not cited in all points it should have been.…”

“…Most case series report no increase in adverse events related to surrogate pregnancy. 1,2,[15][16][17][18] In a recent report, however, 2 out of 9 surrogate mothers had a postpartum hysterectomy: the first for placenta accreta following delivery of triplets; the second following uterine rupture during the delivery of a macrosomic infant. 2,19 The limited evidence on risks associated with surrogate pregnancy means that clinicians should have a high index of suspicion for complications and a low threshold for referral to higher levels of care.…”

New Ethical Horizons in Gestational Surrogacy

“…Conversely, a variety of cell types including stem cells from the pregnant woman cross the placenta and implant into fetal tissues [7,13]. In clinical reports on typical pregnancies [11,14,15], there have been almost 20 case reports showing that a tumor found in the fetus originated from maternal cells that migrated into the fetus during pregnancy [8,9]. So, while maternal-fetal cell exchange has been well documented in women who conceive and carry their own child, there are now studies in animals [16] and humans [12] that document that this process occurs in surrogacy as well.…”

“…There are also several reports presenting data suggesting that fetal cells within a woman may increase her risk for autoimmune disease [19]. At the same time research has also revealed protective effects for the mother that include reducing the risks of infections and cardiac disease [11,14]. Finally, the pregnant woman does not reject the fetus as foreign tissue in part due to the fetal cells within her tissues that tolerize her immune system [20].…”

“…If a baby is born, for example, who is unexpectedly disabled, 3 http://www.thesurrogacyexperience.com/surrogates.cfm?sc=23&p=99 which party would be legally responsible for its care if both the genetic parents and surrogate refuse to accept this responsibility [6,14]. The law cannot force any adult to assume parental responsibility and this child may ultimately end up as a ward ?of the court.…”