{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T21:23:55Z","timestamp":1793654635280,"version":"4.5.1"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Advancements in assisted reproductive technology (ART) have led to an increase in gestational carrier (GC) pregnancies. However, the perinatal outcomes of GC pregnancies remain understudied, necessitating a deeper understanding of their associated risks.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess maternal characteristics and obstetric outcomes associated with GC pregnancies.<\/jats:p><\/jats:sec>Data Sources<\/jats:title>A comprehensive systematic search of publications published before October 31, 2023, using PubMed, Web of Science, Scopus, and Cochrane Library databases was conducted.<\/jats:p><\/jats:sec>Study Selection<\/jats:title>Two authors selected studies examining obstetric characteristics and outcomes in GC pregnancies with 24 or more weeks\u2019 gestation. Studies with insufficient outcome information, unavailable data on gestational surrogacies, and non-English language studies were excluded.<\/jats:p><\/jats:sec>Data Extraction and Synthesis<\/jats:title>Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, 2 investigators extracted and synthesized both quantitative and qualitative data. Both fixed-effect and random-effect analysis were used to pool data.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcomes were obstetric characteristics and outcomes, including hypertensive disorders, preterm birth, and low birth weight. Secondary outcomes included severe maternal morbidity and mortality associated with GC pregnancies.<\/jats:p><\/jats:sec>Results<\/jats:title>Six studies from 2011 to 2023 involving 28\u202f300 GC pregnancies and 1\u202f270\u202f662 non-GC pregnancies were included. GCs accounted for 2.5% of in vitro fertilization cycles (59\u202f502 of 2\u202f374\u202f154 cycles) and 3.8% of ART pregnancies (26\u202f759 of 701\u202f047 ART pregnancies). GC pregnancies were more likely to be conceived by frozen embryo transfer compared with non-GC ART pregnancies (odds ratio [OR], 2.84; 95% CI, 1.56-5.15), and rates of single embryo transfer were similar between the 2 groups (OR, 1.18; 95% CI, 0.94-1.48). GCs were rarely nulliparous (6 of 361 patients [1.7%]) and were more likely to have multifetal pregnancies compared with non-GC ART patients (OR, 1.18; 95% CI, 1.02-1.35). Comparator studies revealed lower odds of cesarean delivery (adjusted OR [aOR], 0.42; 95% CI, 0.27-0.65) and comparable rates of hypertensive disorders (aOR, 0.86; 95% CI, 0.45-1.64), preterm birth (aOR, 0.82; 95% CI, 0.68-1.00), and low birth weight (aOR, 0.79; 95% CI, 0.50-1.26) in GC pregnancies vs non-GC ART pregnancies. Comparatively, GC pregnancies had higher odds of hypertensive disorders (aOR, 1.44; 95% CI, 1.13-1.84) vs general (non-GC ART and non-ART) pregnancies with comparable cesarean delivery risk (aOR, 1.06; 95% CI, 0.90-1.25). Preterm birth and low birth weight data lacked a comparative group using multivariate analysis. Severe maternal morbidity and maternal mortality were rare among GCs.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this systematic review and meta-analysis, although GC pregnancies had slightly improved outcomes compared with non-GC ART pregnancies, they posed higher risks than general pregnancies. Contributing factors may include ART procedures and increased rates of multiple gestations which influence adverse perinatal outcomes in GC pregnancies.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.22634","type":"journal-article","created":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T17:21:45Z","timestamp":1721755305000},"page":"e2422634","source":"Crossref","is-referenced-by-count":12,"title":["Obstetric Characteristics and Outcomes of Gestational Carrier Pregnancies"],"prefix":"10.1001","volume":"7","author":[{"given":"Shinya","family":"Matsuzaki","sequence":"first","affiliation":[{"name":"Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan"},{"name":"Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron D.","family":"Masjedi","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoko","family":"Matsuzaki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Osaka General Medical Center, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary S.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine V.","family":"Erickson","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles"},{"name":"Keck School of Medicine, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel S.","family":"Mandelbaum","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph G.","family":"Ouzounian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Paulson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles"},{"name":"Norris Comprehensive Cancer Center, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,7,23]]},"reference":[{"issue":"2","key":"zoi240724r1","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1093\/humupd\/dmv046","article-title":"Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review.","volume":"22","author":"S\u00f6derstr\u00f6m-Anttila","year":"2016","journal-title":"Hum Reprod Update"},{"issue":"9","key":"zoi240724r2","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1097\/OGX.0000000000000703","article-title":"Surrogacy and pregnancy.","volume":"74","author":"Phillips","year":"2019","journal-title":"Obstet Gynecol Surv"},{"issue":"2","key":"zoi240724r3","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.fertnstert.2016.03.050","article-title":"Trends and outcomes of gestational surrogacy in the United States.","volume":"106","author":"Perkins","year":"2016","journal-title":"Fertil Steril"},{"issue":"1","key":"zoi240724r4","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.fertnstert.2022.05.001","article-title":"Recommendations for practices using gestational carriers: a committee opinion.","volume":"118","author":"Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology. 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