Outcomes for Gestational Carriers Versus Traditional Surrogates in the United States

Fuchs, Erika; Berenson, Abbey B.

doi:10.1089/jwh.2017.6540

Cited by 4 publications

(6 citation statements)

References 9 publications

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“…Of 4231 studies reviewed, 22 studies reported the obstetric outcomes of GC pregnancies ( Figure 1 and eTable 1 in Supplement 1 ). 3 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 Two studies with overlapping data were identified, 22 , 23 and the older study was excluded from the descriptive analysis. 23 Fifteen noncomparator studies were excluded from the main comparator analysis (eTables 2-4 in Supplement 1 ).…”

Section: Resultsmentioning

confidence: 99%

“… 23 Fifteen noncomparator studies were excluded from the main comparator analysis (eTables 2-4 in Supplement 1 ). 18 , 19 , 20 , 21 , 24 , 26 , 27 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 As a result, 6 studies involving 28 300 GC pregnancies and 1 270 662 non-GC pregnancies underwent further descriptive analysis ( Figure 1 ). 3 , 17 , 22 , 25 , 28 , 30 …”

Section: Resultsmentioning

confidence: 99%

“…Given limited information regarding patient characteristics in GCs, descriptive statistics of noncomparator studies are summarized in eTables 2 to 4 in Supplement 1 . 18 , 19 , 20 , 21 , 24 , 26 , 27 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 In the noncomparator studies, the cumulative mean maternal age of GCs, the cumulative rate of multifetal gestation, and the rate of nulliparity results may be consistent with comparator studies and enhance the robustness of the results of the meta-analysis; however, it could not be fully determined because the reported outcomes were different between the comparator and noncomparator studies.…”

Section: Discussionmentioning

confidence: 99%

“…There was a lower prevalence of nulliparity among GC pregnancies (6 of 361 [1.7%]) than among general pregnancies (166 441 of 509 015 [32.7%]) (P < .001); there was also a lower prevalence of nulliparity among GC pregnancies than or non-GC ART pregnancies (350 of 563 [62.2%]) (P < .001). In the noncomparator studies,[18][19][20][21]24,26,27,29,[31][32][33][34][35][36][37] the cumulative mean (range) maternal age of GCs was 34.2(32.7-38.8)…”

mentioning

confidence: 99%

“…When compared with non-GC ART pregnancies, patients with GC pregnancies were more likely to have multiple gestation (OR, 1.18; 95% CI, 1.02-1.35) 3,17,22,25,28. In the noncomparator studies,[18][19][20][21]24,26,27,29,[31][32][33][34][35][36][37] the cumulative rate of multiple gestation (excluding singleton-restricted studies) reached 21.6% (443 of 2055 patients; range 0.0%-34.7%).Figure 2. Meta-Analysis for the Assisted Reproductive Technology (ART) Treatment of Gestational Carrier (GC) Pregnancies…”

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confidence: 99%

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Obstetric Characteristics and Outcomes of Gestational Carrier Pregnancies

Matsuzaki,

Masjedi,

Matsuzaki

et al. 2024

JAMA Netw Open

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ImportanceAdvancements in assisted reproductive technology (ART) have led to an increase in gestational carrier (GC) pregnancies. However, the perinatal outcomes of GC pregnancies remain understudied, necessitating a deeper understanding of their associated risks.ObjectiveTo assess maternal characteristics and obstetric outcomes associated with GC pregnancies.Data SourcesA comprehensive systematic search of publications published before October 31, 2023, using PubMed, Web of Science, Scopus, and Cochrane Library databases was conducted.Study SelectionTwo authors selected studies examining obstetric characteristics and outcomes in GC pregnancies with 24 or more weeks’ gestation. Studies with insufficient outcome information, unavailable data on gestational surrogacies, and non-English language studies were excluded.Data Extraction and SynthesisAdhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, 2 investigators extracted and synthesized both quantitative and qualitative data. Both fixed-effect and random-effect analysis were used to pool data.Main Outcomes and MeasuresThe primary outcomes were obstetric characteristics and outcomes, including hypertensive disorders, preterm birth, and low birth weight. Secondary outcomes included severe maternal morbidity and mortality associated with GC pregnancies.ResultsSix studies from 2011 to 2023 involving 28 300 GC pregnancies and 1 270 662 non-GC pregnancies were included. GCs accounted for 2.5% of in vitro fertilization cycles (59 502 of 2 374 154 cycles) and 3.8% of ART pregnancies (26 759 of 701 047 ART pregnancies). GC pregnancies were more likely to be conceived by frozen embryo transfer compared with non-GC ART pregnancies (odds ratio [OR], 2.84; 95% CI, 1.56-5.15), and rates of single embryo transfer were similar between the 2 groups (OR, 1.18; 95% CI, 0.94-1.48). GCs were rarely nulliparous (6 of 361 patients [1.7%]) and were more likely to have multifetal pregnancies compared with non-GC ART patients (OR, 1.18; 95% CI, 1.02-1.35). Comparator studies revealed lower odds of cesarean delivery (adjusted OR [aOR], 0.42; 95% CI, 0.27-0.65) and comparable rates of hypertensive disorders (aOR, 0.86; 95% CI, 0.45-1.64), preterm birth (aOR, 0.82; 95% CI, 0.68-1.00), and low birth weight (aOR, 0.79; 95% CI, 0.50-1.26) in GC pregnancies vs non-GC ART pregnancies. Comparatively, GC pregnancies had higher odds of hypertensive disorders (aOR, 1.44; 95% CI, 1.13-1.84) vs general (non-GC ART and non-ART) pregnancies with comparable cesarean delivery risk (aOR, 1.06; 95% CI, 0.90-1.25). Preterm birth and low birth weight data lacked a comparative group using multivariate analysis. Severe maternal morbidity and maternal mortality were rare among GCs.Conclusions and RelevanceIn this systematic review and meta-analysis, although GC pregnancies had slightly improved outcomes compared with non-GC ART pregnancies, they posed higher risks than general pregnancies. Contributing factors may include ART procedures and increased rates of multiple gestations which influence adverse perinatal outcomes in GC pregnancies.

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