Gestational surrogacy is a process where a woman, known as the gestational carrier, carries a pregnancy for intended parents using an embryo created through in vitro fertilization, meaning she has no genetic link to the child. Preeclampsia is a serious pregnancy complication characterized by the new onset of high blood pressure and signs of organ damage, such as to the kidneys or liver, usually occurring after 20 weeks of gestation. A previous diagnosis of preeclampsia in a potential carrier presents a complex medical concern that requires thorough evaluation before a woman can be approved for a surrogacy journey.
Understanding Preeclampsia Recurrence
A history of preeclampsia is a serious consideration due to the risk of recurrence in subsequent pregnancies, posing danger to both the carrier and the fetus. Preeclampsia can impair placental function, potentially restricting fetal growth and leading to preterm birth. The overall risk of preeclampsia recurrence in a future pregnancy is estimated to be between 15% and 25%, a rate significantly higher than in the general population.
The statistical likelihood of recurrence varies widely based on the circumstances of the initial diagnosis. If the preeclampsia was severe or required delivery before 34 weeks, the recurrence risk is substantially higher, potentially approaching 50%. Conversely, if the condition was mild and occurred late in the pregnancy, the recurrence risk is much lower. These severe maternal risks, including eclampsia and blood clotting problems, must be avoided in a surrogacy arrangement.
Surrogate Eligibility and Medical Screening
All potential gestational carriers must undergo a rigorous medical review process to ensure the safest possible outcome. This standardized screening begins with a comprehensive review of all prior obstetric and medical records, which must demonstrate a history of uncomplicated, full-term pregnancies. Agencies and fertility clinics aim to mitigate risk, making any history of a severe complication a major hurdle.
General health requirements for surrogacy include being within a specific age range, often between 21 and 40, and maintaining a healthy Body Mass Index (BMI), usually below 33. A high BMI is an independent risk factor for preeclampsia, so a history of the condition combined with an elevated BMI may result in immediate exclusion. The medical records review confirms the exact details of the previous preeclampsia diagnosis, including the gestational week of onset and the outcomes for both mother and child.
The initial assessment is completed by a Reproductive Endocrinologist (RE) at the fertility clinic, who is responsible for determining the medical suitability of the candidate. The RE evaluates the body’s past response to pregnancy and determines the likelihood of a complication-free journey using the intended parents’ embryo. This medical clearance is a non-negotiable step, as it provides the final approval for the surrogate to begin the cycle medications and embryo transfer.
Factors That Determine Acceptance or Exclusion
The decision to accept or exclude a candidate with a history of preeclampsia hinges entirely on the severity, timing, and long-term consequences of the past event. A history of severe preeclampsia is an absolute disqualifier for surrogacy in nearly all cases due to the unacceptably high risk of recurrence and associated dangers. Severe cases often involve very high blood pressure, significant proteinuria, or evidence of end-organ dysfunction, such as impaired liver or kidney function.
Any history of eclampsia (seizures due to preeclampsia) or HELLP syndrome—a severe variant involving hemolysis, elevated liver enzymes, and low platelet count—will permanently disqualify a candidate. These conditions signal a systemic intolerance to pregnancy that places the carrier at extreme risk of maternal morbidity and mortality. Similarly, if the prior preeclampsia required an emergency delivery before 34 weeks, the early onset indicates a more severe underlying issue and a much higher chance of recurrence.
However, a history of mild, late-onset preeclampsia may not be an automatic exclusion and is reviewed on a case-by-case basis. Mild cases that developed after 37 weeks of gestation, resolved quickly after delivery, and did not result in any long-term health consequences for the carrier are the most likely to be considered. In these mitigating scenarios, the condition is often viewed as a temporary complication of that specific pregnancy rather than a chronic risk for all future pregnancies.
If a candidate is considered after a mild episode, extensive testing is required to confirm her current health stability. This often includes a detailed cardiovascular assessment, kidney function tests, and blood pressure monitoring over time to ensure that no lasting organ damage resulted from the prior pregnancy. The ultimate decision rests on the medical team’s confidence that the risk of recurrence is minimal and that the surrogate can safely complete a full-term pregnancy.