Obstet Gynecol Surv. 2026 Jan 1;81(1):7-8. doi: 10.1097/01.ogx.0001179552.76476.7c. Epub 2026 Jan 19.
ABSTRACT
The number of births achieved through a gestational carrier has been increasing. Yet few studies have looked at the mental health outcomes for gestational carriers. Pregnancy increases vulnerability to mental illness, and population-based data suggest that gestational carriers have higher rates of severe maternal morbidity than women in traditional pregnancies. Current guidelines emphasize selecting gestational carriers with stable family supports and requiring psychological evaluation before pregnancy, as up to half of women with prior severe mental illness relapse during pregnancy or postpartum. Risk factors for gestational carriers include emotional separation from the newborn, relationships with intended parents, and societal scrutiny. The aim of this study was to assess the risk of new-onset mental illness among gestational carriers compared with women who conceived unassisted and those who conceived using in vitro fertilization (IVF). This was a population-based study of births >20 weeks of gestation in women between 18 and 50 years of age from 2012 through 2021 in a universal health care system in Ontario, Canada. Excluded were women with a history of an infertility diagnosis or prior mental illness, and a medical condition that would preclude them from selecting a gestational carrier. The primary outcome was new-onset mental illness, such as a mood disorder, anxiety disorder, psychosis, substance use disorder, self-harm event, or other mental illness, based on ≥2 outpatient visits or ≥1emergency department visit or hospital admission. A total of 767,406 pregnancies were included in the analysis. Of these, 97.6% were conceived unassisted, 2.3% conceived by IVF, and 0.1% used a gestational carrier. Gestational carriers were more likely to be parous [91.2% vs. 57.9% (unassisted conception) and 34.1% (IVF)] and live in lower-income areas [23.4% vs. 21.9% (unassisted) and 12.1% (IVF)]. They also have a higher rate of obesity [36.1% vs. 17% (unassisted) and 17.1% (IVF)] and chronic hypertension [3.2% vs. 1.6% (unassisted) and 2.9% (IVF)]. After a median (IQR) follow-up of 4.5 (2.3 to 7.2) years, new-onset mental illness occurred in 236 gestational carriers compared with 195,022 women who conceived unassisted [6.9 vs. 5.2 per 100 person-years; incidence rate ratios (IRRs), 1.43; 95% CI, 1.26 to 1.63) and with 4704 women receiving IVF (6.9 vs. 5.0 per 100 person-years; adjusted IRR, 1.29; 95% CI, 1.13 to 1.47). The median (IQR) time from the estimated date of conception to a diagnosis of mental illness was 2.39 (1.11 to 4.19) years for gestational carriers versus 2.29 (1.02 to 4.34) years for those who conceived unassisted and 2.72 (1.11 to 4.82) years for those who used IVF. In conclusion, gestational carriers are more likely to be diagnosed with mental illness than women who conceive unassisted or use IVF. This study highlights the importance of enhanced mental health screening and support for gestational carriers.(Abstracted from: JAMA Netw Open. 2025;8(7):e2523428.).
PMID:41557919 | DOI:10.1097/01.ogx.0001179552.76476.7c
