Surrogacy offers a path for individuals and couples to build their families. For those considering becoming a gestational surrogate, various medical factors are evaluated to ensure a healthy pregnancy. A personal history of preeclampsia requires careful assessment.
Understanding Preeclampsia
Preeclampsia is a pregnancy complication characterized by high blood pressure and organ damage, often to the liver and kidneys. It usually develops after 20 weeks of pregnancy, though it can occur earlier or shortly after delivery. Signs include excess protein in the urine, severe headaches, vision changes, and abdominal pain.
Untreated preeclampsia can lead to complications for both the pregnant individual and the baby. Risks for the pregnant person include kidney or liver damage, fluid in the lungs, and in severe cases, seizures (eclampsia) or stroke. For the baby, preeclampsia can result in growth restriction, premature birth, and low birth weight. Severity ranges from mild to severe, classified by onset (early or late in pregnancy).
General Health Criteria for Surrogacy
Gestational surrogates must meet general health requirements for a safe pregnancy. Most programs require candidates to be 21 to 40 years old, an age range associated with fewer pregnancy risks. A healthy Body Mass Index (BMI), generally 19-35, is also expected to minimize complications like gestational diabetes or high blood pressure.
Prospective surrogates must have a history of at least one successful, uncomplicated pregnancy and delivery without major complications (e.g., preterm labor or significant medical intervention). This experience demonstrates the body’s ability to carry a pregnancy to term and ensures understanding of the physical and emotional aspects. Overall physical and mental well-being is also assessed for stability throughout the surrogacy journey. Candidates must be free from smoking or illicit drug use.
How Preeclampsia Affects Surrogacy Eligibility
A history of preeclampsia does not automatically disqualify a gestational surrogate candidate, but it requires a thorough, individualized medical evaluation. Severity of the previous preeclampsia episode is a primary factor; mild or moderate cases are more likely to be considered with complete, documented recovery. Conversely, severe preeclampsia, particularly if it involved HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) or eclampsia (seizures), typically renders a candidate ineligible due to elevated risks.
Timing of preeclampsia onset in the prior pregnancy also influences eligibility. If the condition developed late in pregnancy (e.g., after 34-37 weeks) and resolved quickly after birth, it is generally viewed more favorably than early-onset preeclampsia. Any residual complications or organ damage from previous preeclampsia (e.g., kidney or liver dysfunction) would also preclude eligibility. Medical teams look for a full recovery with stable blood pressure since the last pregnancy.
A prior history of preeclampsia increases recurrence risk in subsequent pregnancies. Recurrence risk varies significantly, ranging from approximately 5% to 80%, depending on severity and gestational age at previous occurrence. Early-onset and severe preeclampsia carry substantially higher recurrence rates, with a 60-90% chance for early-onset cases. There is also an elevated risk for gestational hypertension and potential placental complications in a future pregnancy. Surrogacy agencies and fertility clinics approach such cases cautiously to minimize risks for both the gestational carrier and the baby, requiring careful medical clearance from specialists.
The Surrogate Medical Screening Process
Potential gestational surrogates undergo comprehensive medical screening to assess their health and suitability for carrying another pregnancy. This evaluation typically begins with a detailed review of prior medical records, focusing on previous pregnancies, including any history of preeclampsia, delivery details, and postpartum recovery. This record review helps medical professionals understand obstetric history and identify potential concerns.
Following the record review, candidates typically undergo a physical examination. This includes a general physical assessment, pelvic exam, Pap smear, and uterine evaluation (ultrasound or sonohysterogram) to check for abnormalities like fibroids or polyps that could affect embryo implantation or pregnancy. Laboratory tests are also conducted, including blood tests for infectious diseases, overall health markers (e.g., complete blood count, metabolic panel), and urine tests for protein. The collected medical information is then reviewed by fertility specialists (e.g., reproductive endocrinologists) and often an obstetrician. This multi-faceted assessment aims to evaluate the candidate’s health, identify specific risks related to their medical history, and ensure the safety of both the potential surrogate and the future pregnancy.