198: Guidelines for gestational carriers: a population-based assessment of adherence and outcomes

Abstract

We aim to evaluate whether non-adherence to American Society for Reproductive Medicine (ASRM) safety guidelines for gestational carriers (GCs) is associated with increased risk of severe obstetric and perinatal morbidity and mortality. This is a cross-sectional study of birth certificate data from GC pregnancies in Utah between 2009 and 2018. Violations of guidelines include age < 21 or >45, nulliparity, prior stillbirth, tobacco or percutaneous drug use, >5 prior deliveries, >3 prior cesarean delivery (CD), major comorbidities or mental health conditions. The primary outcome was a composite outcome of severe obstetric morbidity and mortality (death within one year of delivery, intensive care unit admission, eclampsia, HELLP syndrome, transfusion, unplanned hysterectomy). Secondary outcomes were cesarean delivery (CD), gestational diabetes (GDM), pregnancy related hypertension, as well as a composite perinatal outcome. Associations were measured with descriptive statistics and uni- and multi-variable logistic regression. 361 GC deliveries of 435 neonates were included. 16% (58/361) of GCs did not meet guidelines (figure). Rates of severe obstetric morbidity or mortality did not differ among GCs that did and did not meet guidelines (2% for both, p=0.97). Rate of CD was clinically, but not statistically, different between GCs that did and did not meet guidelines (25% versus 36%, p=0.07). Rates of GDM and pregnancy related hypertension did not differ. Perinatal complications were significantly more common in GCs that did not meet guidelines (table), even after adjusting for gestational age and multifetal gestation, with an adjusted odds ratio of 2.9 (95% confidence interval 1.2-6.9). Nearly one in five GC pregnancies are non-adherent to ASRM guidelines. Non-adherence is associated with increased perinatal morbidity and mortality. With GC pregnancies rapidly increasing, future research should focus on the safety of GCs and on why non-adherence occurs.View Large Image Figure ViewerDownload Hi-res image Download (PPT)