A history of preeclampsia does not automatically disqualify a woman from serving as a gestational surrogate. Preeclampsia is characterized by the sudden onset of high blood pressure and signs of damage to organ systems, most commonly the liver and kidneys, typically occurring after 20 weeks of gestation. Because this condition poses significant risks to both the carrier and the fetus, a prior diagnosis necessitates a complex, individualized medical review to determine eligibility for surrogacy.
Understanding Preeclampsia and Its Recurrence Risk
Preeclampsia is a disorder of the placenta and blood vessels that results in elevated blood pressure (140/90 mm Hg or higher) and signs of maternal organ dysfunction. Untreated or severe preeclampsia can progress to eclampsia (seizures) or HELLP syndrome, a life-threatening liver and blood clotting disorder. The condition is a major cause of medically induced preterm delivery and can lead to fetal growth restriction due to compromised blood flow to the placenta. These complications introduce unacceptable risks for a surrogacy arrangement, where the safety of the carrier and the baby is paramount.
The most significant concern for fertility clinics is the increased likelihood of the condition returning in a subsequent pregnancy, known as the recurrence risk. For women who experienced preeclampsia near term, the chance of recurrence is approximately 10%. This risk rises substantially for those who had severe features (such as HELLP syndrome or eclampsia) or if the onset was early in the previous pregnancy. If preeclampsia manifested before 30 weeks of gestation, the risk of recurrence can be as high as 40 to 50%.
Surrogacy Eligibility Guidelines Regarding Preeclampsia History
Surrogacy agencies and fertility clinics maintain strict medical standards to protect the health of the surrogate and the baby. A history of severe preeclampsia, especially one that resulted in organ failure, eclampsia, or a delivery before 34 weeks, is generally considered a disqualifier. These outcomes indicate a higher chance of recurrence and potential long-term maternal health issues, such as chronic hypertension or kidney disease.
A candidate may remain eligible if her previous preeclampsia was classified as mild, occurred late in the third trimester, and resolved fully with no lasting organ damage. The decision hinges on specific details, including the exact week of delivery and the complete absence of any residual high blood pressure or proteinuria following the birth. Waiting a minimum of six to twelve months post-delivery is required to ensure a documented full recovery.
The Medical Screening Process for High-Risk Candidates
For women with a preeclampsia history, the medical screening process is rigorous. The initial step involves a thorough collection and review of all previous prenatal and hospital delivery records, including blood pressure logs, laboratory results, and physician notes. This documentation allows the medical director to precisely assess the severity and timing of the past condition.
Following the records review, the candidate must undergo a comprehensive current health assessment, including a physical examination and extensive blood work. Laboratory tests confirm normal baseline kidney and liver function, the organ systems most often compromised by preeclampsia. If the initial review suggests a higher risk, the clinic may require a consultation with a maternal-fetal medicine specialist for final clearance. The final decision rests solely with the medical director, who must be confident that the risks are manageable and acceptable.
Managing a Surrogacy Pregnancy After a Preeclampsia History
If a candidate with a preeclampsia history is deemed eligible, the subsequent pregnancy will be treated as high-risk from the start. A primary preventative measure involves the prophylactic use of low-dose aspirin, which is usually started after the twelfth week of gestation. This regimen reduces the risk of preeclampsia recurrence in high-risk populations.
The surrogate will require heightened medical surveillance, including more frequent prenatal visits, regular blood pressure monitoring, and periodic laboratory tests to check for early signs of organ stress. The intended parents and the clinic must arrange for the surrogate to receive care from a specialized high-risk obstetrics team. This proactive management strategy is designed to detect and treat any signs of recurrence immediately, minimizing potential harm to both the surrogate and the baby.