The psychological well-being and prenatal bonding of gestational surrogates

Abstract

STUDY QUESTIONHow does the psychological well-being and prenatal bonding of Indian surrogates differ from a comparison group of mothers?SUMMARY ANSWERSurrogates had higher levels of depression during pregnancy and post-birth, displayed lower emotional connection with the unborn baby, and greater care towards the healthy growth of the foetus, than the comparison group of mothers.WHAT IS ALREADY KNOWNStudies in the West have found that surrogates do not suffer long-term psychological harm. One study has shown that surrogates bond less with the foetus than expectant mothers.STUDY, DESIGN, SIZE, DURATIONThis study uses a prospective, longitudinal and cross-sectional design. Surrogates and a matched group of expectant mothers were seen twice, during 4–9 months of pregnancy and 4–6 months after the birth.PARTICIPANTS/MATERIALS, SETTING, METHODSSemi-structured interviews and standardized questionnaires were administered to 50 surrogates and 69 expectant mothers during pregnancy and 45 surrogates and 49 expectant mothers post-birth. All gestational surrogates were hosting pregnancies for international intended parents.MAIN RESULTS AND THE ROLE OF CHANCESurrogates had higher levels of depression compared to the comparison group of mothers, during pregnancy and post-birth (P < 0.02). Low social support during pregnancy, hiding surrogacy and criticism from others were found to be predictive of higher depression in surrogates post-birth (P < 0.05). Regarding prenatal bonding, surrogates interacted less with and thought less about the foetus but adopted better eating habits and were more likely to avoid unhealthy practices during pregnancy, than expectant mothers (P < 0.05). No associations were found between greater prenatal bonding and greater psychological distress during pregnancy or after relinquishment.LIMITATIONS, REASONS FOR CAUTIONAll surrogates were recruited from one clinic in Mumbai, and thus the representativeness of this sample is not known. Also, the possibility of socially desirable responding from surrogates cannot be ruled out.WIDER IMPLICATIONS OF THE FINDINGSAs this is the first study of the psychological well-being of surrogates in low-income countries, the findings have important policy implications. Providing support and counselling to surrogates, especially during pregnancy, may alleviate some of the psychological problems faced by surrogates.STUDY FUNDING/COMPETING INTEREST(S)This study was supported by the Wellcome Trust [097857/Z/11/Z] and Nehru Trust, Cambridge. K.K. is the Medical Director of Corion Fertility Clinic. All other authors have no conflict of interest to declare.

Prenatal Attachment and Perinatal Depression: A Systematic Review

“…The included studies were mainly conducted in the US (10 papers) [80,[84][85][86][87][88][89][90][91][92] and in Europe (nine papers in Italy [93][94][95][96][97][98][99][100][101], four in Sweden [76,[102][103][104], two in Germany [105,106], one in the Netherlands [22], one in France [107], one in England [79], one in Belgium [108], and one in Portugal [75]). Four studies were carried out in Japan [81,[109][110][111], two in Australia [112,113], two in Iran [74,114], two in Turkey [78,115], one in India [116], one in Israel [117], one in Chile [118], one in Brazil [119], and one in Korea [120] (Figure 2). All the articles were published between 1988 and 2019 (…”

“…Considering the 45 studies included in the current review, 31 found a negative association between prenatal attachment and perinatal depression [22,74,75,81,84,86,[89][90][91][92]95,[97][98][99]101,102,[104][105][106][107][108][110][111][112][114][115][116][117][118][119][120], while a positive relation between perinatal depression and some dimensions of antenatal attachment was identified in three studies [94,102,106]. Thirteen studies did not highlight significant associations between these variables [76,[78][79][80]85,87,88,93,96,100,103,109,113].…”

“…Thirteen studies did not highlight significant associations between these variables [76,[78][79][80]85,87,88,93,96,100,103,109,113]. Specifically, the majority of the articles (28) observed a negative association between prenatal depressive symptoms and prenatal attachment [22,75,81,84,86,[89][90][91][92]94,97,98,102,[104][105][106][107][108][110][111][112][114][115][116][117][118][119][120]. In contrast, a positive association between prenatal depression and some dimensions of prenatal attachment (i.e., the "physical contact with the fetus and sensitivity to the fetal movement" subscale of the MFAS [102], the "empathy" subscale of the German version of the MFAS [106], and the "fantasy" and the "maternal sensitivity to the fetus" factors of the PAI [94]) was found in three studies…”

“…Nineteen of the 29 studies that administered prenatal attachment instruments in the second or the third trimester of gestation underlined a significant association between the two considered variables [22,74,84,86,[90][91][92]95,97,98,101,102,[104][105][106]112,[115][116][117]: 16 studies confirmed a negative association between prenatal attachment and prenatal depression [22,84,86,[90][91][92]97,98,102,[104][105][106]112,[115][116][117] and six studies identified a negative association between prenatal attachment and postnatal depression [74,95,101,105,116,117], while a positive relation was found between prenatal depression and some factors of prenatal attachment in two studies [102,106]. Even if they assessed prenatal attachment in the recommended gestational period, ten articles did not demonstrate a significant association between prenatal attachment and prenatal depression…”

Legality of Surrogacy with Special Reference to Surrogacy Bill 2019

“…Additionally, a woman cannot become a surrogate mother by providing her own gametes (unfertilised eggs). (Lamba et al 2018) When is surrogacy permitted? As per the Bill, only altruistic surrogacy will be permitted in India, in cases where either or both members of the couple suffer from infertility, of which the certificate of essentiality is proof.…”