A history of gestational diabetes mellitus (GDM) is a frequent concern for women considering gestational surrogacy. The medical evaluation heavily scrutinizes a candidate’s past pregnancies to ensure the safest possible journey for both the carrier and the fetus. While a previous GDM diagnosis introduces a complication, it does not automatically disqualify a potential surrogate. Stringent medical review is required to confirm that the condition was temporary and has not progressed into a long-term metabolic disorder. Eligibility rests on a comprehensive evaluation of the candidate’s current health and demonstrated metabolic stability.
Understanding Gestational Diabetes and Surrogacy Risk
Gestational Diabetes Mellitus (GDM) is a temporary form of glucose intolerance first diagnosed during pregnancy, typically in the second or third trimester. This condition arises when pregnancy hormones interfere with the body’s ability to use insulin effectively, leading to elevated blood sugar levels. Although GDM usually resolves after delivery, it serves as a significant marker of a woman’s underlying predisposition to insulin resistance.
A history of GDM is a major factor in surrogacy screening because it significantly increases the risk of recurrence in a subsequent pregnancy. For women who have had GDM once, the chance of developing it again is estimated to be around 40% to 50%, compared to a much lower risk for the general population. This heightened recurrence risk is the core medical concern, as uncontrolled blood sugar during pregnancy can lead to several complications.
The recurrence of GDM poses risks to the carrier, including an increased likelihood of developing preeclampsia, requiring a Cesarean section delivery, and later developing Type 2 diabetes. For the fetus, poor glucose control can lead to excessive birth weight (macrosomia), increasing the risk of birth injury. It can also contribute to polyhydramnios (excess amniotic fluid) and increase the risk of neonatal hypoglycemia shortly after birth. Mitigating these risks is the primary medical justification for the strict screening protocols.
Standard Medical Screening and General Eligibility Requirements
Before any specific testing for GDM history, all potential gestational carriers must meet baseline health requirements established by the American Society for Reproductive Medicine (ASRM) and individual fertility clinics. These criteria are designed to ensure a high probability of a healthy, full-term pregnancy and to protect the surrogate’s health.
The general age parameters for surrogacy typically fall between 21 and 40 years old. A candidate must also have a history of at least one previous, uncomplicated, full-term pregnancy and delivery, demonstrating her ability to carry a baby successfully. This history of successful delivery is non-negotiable and provides evidence of a functional uterus and healthy obstetrical outcomes.
A healthy Body Mass Index (BMI) is a universal requirement, with most clinics mandating a BMI between 19 and 32. Maintaining a BMI within this range helps reduce the overall risk of pregnancy complications, including the recurrence of GDM, and is part of the clearance for In Vitro Fertilization (IVF) procedures. Candidates undergo a psychological evaluation to assess their mental stability and readiness for the emotional demands of the surrogacy process.
Navigating Past GDM: Specific Eligibility Protocols
For a candidate with a history of GDM to be medically cleared, the focus shifts to proving that the prior metabolic challenge was transient and fully resolved. The Reproductive Endocrinologist (REI) at the fertility clinic requires specific laboratory evidence of current metabolic health.
The most routine blood test for this clearance is the Hemoglobin A1c (HbA1c), which provides a three-month average of blood sugar control. The A1c level must fall within the normal, non-diabetic range, typically below 5.7%, to demonstrate effective glucose regulation. An HbA1c level of 6.5% or higher is an automatic disqualifier, as it indicates existing diabetes. Levels between 5.7% and 6.4% signal pre-diabetes, requiring further investigation or temporary disqualification.
In addition to the A1c, the REI may require a repeat Oral Glucose Tolerance Test (OGTT) to definitively confirm current insulin sensitivity. This repeat testing is especially likely if the initial GDM was managed with insulin or if the surrogate’s BMI is at the higher end of the acceptable range. The candidate must also provide medical records documenting that the GDM fully resolved after her previous delivery, confirmed by a normal postpartum glucose screening.
The review process is highly individualized. Some clinics are more cautious if the GDM caused complications, such as preeclampsia or fetal macrosomia, or if it occurred in multiple prior pregnancies. Eligibility requires demonstrating strict, sustained metabolic control and an absence of current signs of pre-diabetes or Type 2 diabetes, ensuring the safest environment for the transferred embryo.