Severe Maternal and Neonatal Morbidity Among Gestational Carriers : A Cohort Study.

IF 19.6 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

Annals of Internal Medicine Pub Date : 2024-11-01 Epub Date: 2024-09-24 DOI:10.7326/M24-0417

Maria P Velez, Marina Ivanova, Jonas Shellenberger, Jessica Pudwell, Joel G Ray

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引用次数: 0

Abstract

Background: Use of a gestational ("surrogate") carrier is increasingly common. Risk for maternal and neonatal adversity is largely unknown in this birthing population.

Objective: To determine the risk for severe maternal morbidity (SMM) and severe neonatal morbidity (SNM) in gestational carriers.

Design: Population-based cohort study.

Setting: All of Ontario, Canada.

Participants: All singleton births at more than 20 weeks' gestation, from 2012 to 2021.

Measurements: Exposure was type of conception, namely, gestational carriage (main exposure), unassisted conception (comparison group 1), and in vitro fertilization (IVF) (comparison group 2). Main composite outcomes were SMM and SNM. Modified Poisson regression models generated weighted relative risks (wRRs) using propensity score-based overlap weighting. Secondary outcomes included hypertensive disorders of pregnancy, cesarean delivery, preterm birth, and postpartum hemorrhage.

Results: Of all eligible singleton births, 846 124 (97.6%) were by unassisted conception, 16 087 (1.8%) by IVF, and 806 (0.1%) by gestational carriage. Respective risks for SMM were 2.3%, 4.3%, and 7.8%. The wRRs were 3.30 (95% CI, 2.59 to 4.20) comparing gestational carriage with unassisted conception and 1.86 (CI, 1.36 to 2.55) comparing gestational carriage with IVF. Respective risks for SNM were 5.9%, 8.9%, and 6.6%, generating wRRs of 1.20 (CI, 0.92 to 1.55) for gestational carriage versus unassisted conception and 0.81 (CI, 0.61 to 1.08) for gestational carriage versus IVF. Hypertensive disorders, postpartum hemorrhage, and preterm birth at less than 37 weeks were also significantly higher contrasting gestational carriers to either comparison group.

Limitation: Absence of information about indications for choosing a gestational carrier, and oocyte or sperm donor source.

Conclusion: Among singleton births of more than 20 weeks' gestation, a higher risk for SMM and adverse pregnancy outcomes was seen among gestational carriers compared with women who conceived with and without assistance. Although gestational carriage was associated with preterm birth, there was less clear evidence of severe neonatal morbidity. Potential mechanisms for higher maternal morbidity among gestational carriers require elucidation, alongside developing special care plans for gestational carriers.

Primary funding source: The Canadian Institutes of Health Research.

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妊娠带原者的严重孕产妇和新生儿发病率：一项队列研究。

背景：使用妊娠（"代孕"）携带者的情况越来越普遍。在这一分娩人群中，孕产妇和新生儿的不良风险在很大程度上是未知的：目的：确定妊娠带原者的严重孕产妇发病率（SMM）和严重新生儿发病率（SNM）风险：设计：基于人群的队列研究：地点：加拿大安大略省全境：所有妊娠超过 20 周的单胎新生儿，时间为 2012 年至 2021 年：暴露为受孕类型，即妊娠携带（主要暴露）、非辅助受孕（对比组 1）和体外受精（对比组 2）。主要综合结果为SMM和SNM。修正的泊松回归模型采用基于倾向评分的重叠加权法生成加权相对风险（wRR）。次要结果包括妊娠高血压疾病、剖宫产、早产和产后出血：在所有符合条件的单胎产妇中，846 124例（97.6%）为人工受孕，16 087例（1.8%）为体外受精，806例（0.1%）为妊高症。SMM的风险分别为2.3%、4.3%和7.8%。妊娠带毒与人工受孕的wRR为3.30（95% CI，2.59至4.20），妊娠带毒与体外受精的wRR为1.86（CI，1.36至2.55）。SNM的风险分别为5.9%、8.9%和6.6%，妊娠带卵与人工受孕的wRR为1.20（CI，0.92至1.55），妊娠带卵与体外受精的wRR为0.81（CI，0.61至1.08）。高血压疾病、产后出血和小于37周的早产率也明显高于妊娠带原者和对比组：局限性：缺乏有关选择妊娠携带者的适应症、卵细胞或精子捐献者来源的信息：结论：在妊娠超过20周的单胎产妇中，妊娠带原者与有助孕和无助孕的产妇相比，患SMM和不良妊娠结局的风险更高。虽然妊娠带原者与早产有关，但新生儿严重发病率的证据并不明显。需要阐明妊娠带原者孕产妇发病率较高的潜在机制，同时为妊娠带原者制定特殊的护理计划：主要资金来源：加拿大卫生研究院。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Internal Medicine 医学-医学：内科

CiteScore

23.90

自引率

1.80%

发文量

1136

审稿时长

3-8 weeks

期刊介绍： Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.