One in four gestational carriers do not meet the ASRM guidelines
In a recent cohort study, researchers have found that nearly one in four gestational carrier pregnancies do not meet the American Society for Reproductive Medicine (ASRM) guidelines. They also found non-adherence of ASRM guidelines have increased the spontaneous abortion by 5 folds. The research has been published in the journal Fertility and Sterility.
Deviation from gestational carrier guidelines was common in gestational carrier pregnancies and associated with increased risk of neonatal morbidity and preterm delivery. Researchers of the University of California conducted a study to evaluate whether criteria described by ASRM guidelines for gestational carriers and additionally, non-described factors are associated with an increase in poor obstetric and or neonatal outcomes.
It was a single centric cross-sectional study of births from 194 gestational carrier pregnancies between 2008 and 2019. The major outcome assessed were clinical pregnancy, biochemical pregnancy, preterm delivery, term delivery, and pregnancy complications. Violations of ASRM guidelines were determined as age <21 or >45 years, nulliparity, prior stillbirth, tobacco or percutaneous drug use, >5 prior deliveries, >3 prior cesarean delivery (CD), major comorbidities or mental health conditions, BMI >35, and short interval pregnancy (<12 months).
Key findings of the study were:
• Among 194 gestational carriers, researchers found twenty-five per cent (50/194) did not meet ASRM criteria, with BMI >35 (38%) and age (mostly >45 or <21) (36%) being the most common criteria violated.
• They identified seventy-six per cent of carrier pregnancies (148/194) were mediated through a surrogacy agency and were more likely to adhere to ASRM guidelines (OR 3.02) than who was not mediated through agencies.
• After categorizing patients in adherence and non-adherence of ASRM guidelines they found that complete adherence group did not alter rates of antepartum complications, intrapartum complications, and postpartum complications. However, those in the non-adherence cohort were found to have a significantly increased risk of spontaneous abortion (OR 4.89).
• Upon multivariate logistic regression adjusting for each ASRM guideline factor, they found age >45 (aOR 3.98) and BMI > 35 (aOR 4.89) were notable predictors of spontaneous abortion in non-guideline adherent gestation carrier pregnancies.
• They noted gestational carriers with a history of a prior spontaneous abortion were more likely to experience a biochemical pregnancy (OR 3.2) and those with a history of prior preterm birth were more likely to experience a spontaneous abortion (OR 3.19)
The authors concluded, "Nearly one in four gestational carrier pregnancies in this cohort did not meet ASRM guidelines. Guidelines are less likely to be followed when a gestational carrier is found through means other than an agency".
They further added, "Non-adherence to ASRM guidelines was associated with an almost 5-fold increase in odds of spontaneous abortion -- the history of prior spontaneous abortion and preterm births are important historical factors to rigorously account for when making carrier selection".
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