{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:17:31Z","timestamp":1788913051588,"version":"build-2803163510"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Pregnancy is a period of increased vulnerability for psychological well-being. The mental health of gestational carriers is understudied.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To study the association between gestational carriage and new-onset mental illness.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This population-based, retrospective cohort study included all women from the entire province of Ontario, Canada, without known mental illness before pregnancy and who gave birth at greater than 20 weeks\u2019 gestation from April 1, 2012, to March 31, 2021. Data were analyzed from September 10, 2024, to May 23, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Gestational carriers were contrasted with non\u2013gestational carriers who conceived unassisted (comparison 1) or by in vitro fertilization (IVF) (comparison 2).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The main outcome was a diagnosis of new-onset mental illness based on 2 or more outpatient visits or 1 or more emergency department visit or hospital admission and occurring from the estimated date of conception up to a maximum follow-up date of March 31, 2024. Modified Poisson regression\u2013generated incidence rate ratios (IRRs) adjusted for maternal age, income quintile, urban residence, obesity, smoking, parity, and chronic hypertension.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 767 406 eligible pregnancies in women (mean [SD] age, 30.5 [5.1] years), 748\u202f732 (97.6%) were by unassisted conception, 17\u202f916 (2.3%) by IVF, and 758 (0.1%) by gestational carriage. Gestational carriers were more likely than unassisted conception and IVF carriers to be parous (91.2% vs 57.9% and 34.1%, respectively), reside in a lower-income area (23.4% vs 21.9% and 12.1%, respectively), and have higher rates of obesity (36.1% vs 17.0% and 17.1%, respectively) and chronic hypertension (3.2% vs 1.6% and 2.9%, respectively). The median (IQR) follow-up was 4.5 (2.3-7.2) years. In comparison 1, new-onset mental illness occurred in 236 gestational carriers (6.9 per 100 person-years) vs 195\u202f022 women with unassisted conception (5.2 per 100 person-years) (adjusted IRR, 1.43; 95% CI, 1.26-1.63). In comparison 2, new-onset mental illness occurred among 236 gestational carriers (6.9 per 100 person-years) and 4704 women receiving IVF (5.0 per 100 person-years) (adjusted IRR, 1.29; 95% CI, 1.13-1.47).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The findings of this cohort study suggest that gestational carriers were more likely to be diagnosed with mental illness during and after pregnancy. Mental health screening, counseling, and provision of support may be particularly important in this population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.23428","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T15:30:33Z","timestamp":1753457433000},"page":"e2523428","source":"Crossref","is-referenced-by-count":5,"title":["New-Onset Mental Illness Among Gestational Carriers"],"prefix":"10.1001","volume":"8","author":[{"given":"Maria P.","family":"Velez","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada"},{"name":"Research Institute, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Dayan","sequence":"additional","affiliation":[{"name":"Research Institute, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Department of Medicine, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone N.","family":"Vigod","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Psychiatry and Women\u2019s College Research and Innovation Institute, Women\u2019s College Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Buckett","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney","family":"Flatt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Shellenberger","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel G.","family":"Ray","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Department of Medicine and Obstetrics and Gynaecology, St Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,7,25]]},"reference":[{"issue":"17","key":"zoi250675r1","doi-asserted-by":"publisher","first-page":"1691","DOI":"10.1001\/jama.2023.11023","article-title":"Trends and outcomes of assisted reproductive technology cycles using a gestational carrier between 2014 and 2020.","volume":"330","author":"Shandley","year":"2023","journal-title":"JAMA"},{"issue":"11","key":"zoi250675r2","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.7326\/M24-0417","article-title":"Severe maternal and neonatal morbidity among gestational carriers: a cohort study.","volume":"177","author":"Velez","year":"2024","journal-title":"Ann Intern Med"},{"issue":"2","key":"zoi250675r3","doi-asserted-by":"publisher","first-page":"E430","DOI":"10.9778\/cmajo.20210269","article-title":"Infertility treatment and postpartum mental illness: a population-based cohort study.","volume":"10","author":"Dayan","year":"2022","journal-title":"CMAJ Open"},{"issue":"2","key":"zoi250675r4","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1001\/jamapsychiatry.2013.279","article-title":"Perinatal episodes across the mood disorder spectrum.","volume":"70","author":"Di Florio","year":"2013","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"zoi250675r5","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. Electronic address: asrm@asrm.org","year":"2022","journal-title":"Fertil Steril"},{"issue":"6","key":"zoi250675r6","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1016\/j.jogc.2020.01.016","article-title":"A report on the supports and barriers of surrogacy in Canada.","volume":"42","author":"Fantus","year":"2020","journal-title":"J Obstet Gynaecol Can"},{"issue":"5","key":"zoi250675r7","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1016\/j.fertnstert.2020.03.010","article-title":"Postdelivery adjustment of gestational carriers, intended parents, and their children.","volume":"113","author":"Jadva","year":"2020","journal-title":"Fertil Steril"},{"issue":"4","key":"zoi250675r8","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.fertnstert.2023.01.015","article-title":"Consideration of the gestational carrier: an Ethics Committee opinion.","volume":"119","author":"Ethics Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org","year":"2023","journal-title":"Fertil Steril"},{"issue":"8","key":"zoi250675r9","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1177\/070674371506000805","article-title":"Validation of a population-based algorithm to detect chronic psychotic illness.","volume":"60","author":"Kurdyak","year":"2015","journal-title":"Can J Psychiatry"},{"issue":"10","key":"zoi250675r10","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1097\/00005650-200410000-00004","article-title":"Using administrative data to measure ambulatory mental health service provision in primary care.","volume":"42","author":"Steele","year":"2004","journal-title":"Med Care"},{"issue":"1","key":"zoi250675r11","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1093\/humupd\/dml039","article-title":"Psychosocial aspects of surrogate motherhood.","volume":"13","author":"van den Akker","year":"2007","journal-title":"Hum Reprod Update"},{"issue":"2","key":"zoi250675r12","doi-asserted-by":"publisher","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":"5","key":"zoi250675r13","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1016\/j.fertnstert.2020.02.104","article-title":"Psychological assessment of gestational carrier candidates: current approaches, challenges, and future considerations.","volume":"113","author":"Riddle","year":"2020","journal-title":"Fertil Steril"},{"issue":"1","key":"zoi250675r14","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/j.1365-2850.2008.01324.x","article-title":"Nursing the disenfranchised: women who have relinquished an infant for adoption.","volume":"16","author":"Aloi","year":"2009","journal-title":"J Psychiatr Ment Health Nurs"},{"key":"zoi250675r15","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.887660","article-title":"Gender, Addiction, and Removal of Children Into Care.","volume":"13","author":"Russell","year":"2022","journal-title":"Front Psychiatry"},{"issue":"5","key":"zoi250675r16","doi-asserted-by":"publisher","first-page":"e208","DOI":"10.1097\/AOG.0000000000002927","article-title":"ACOG Committee Opinion No. 757: screening for perinatal depression.","volume":"132","author":"ACOG Committee Opinion No","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"3","key":"zoi250675r17","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1111\/1471-0528.12837","article-title":"Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care.","volume":"122","author":"Woolhouse","year":"2015","journal-title":"BJOG"},{"issue":"7","key":"zoi250675r18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.22634","article-title":"Obstetric characteristics and outcomes of gestational carrier pregnancies: a systematic review and meta-analysis.","volume":"7","author":"Matsuzaki","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"5","key":"zoi250675r19","doi-asserted-by":"publisher","first-page":"926","DOI":"10.1016\/j.fertnstert.2022.07.028","article-title":"Mode of conception and risk of spontaneous vs. provider-initiated preterm birth: population-based cohort study.","volume":"118","author":"Wang","year":"2022","journal-title":"Fertil Steril"},{"issue":"4","key":"zoi250675r20","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.8496","article-title":"Multifetal pregnancy after implementation of a publicly funded fertility program.","volume":"7","author":"Velez","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"9","key":"zoi250675r21","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1016\/j.jogc.2022.05.012","article-title":"Severe maternal morbidity and maternal mortality associated with assisted reproductive technology.","volume":"44","author":"Sabr","year":"2022","journal-title":"J Obstet Gynaecol Can"},{"issue":"1","key":"zoi250675r22","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1186\/s12884-021-03938-8","article-title":"Assisted reproductive technology and hypertensive disorders of pregnancy: systematic review and meta-analyses.","volume":"21","author":"Chih","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"zoi250675r23","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1186\/s12884-021-03711-x","article-title":"Caesarean section in pregnancies conceived by assisted reproductive technology: a systematic review and meta-analysis.","volume":"21","author":"Lodge-Tulloch","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"issue":"12","key":"zoi250675r24","doi-asserted-by":"publisher","first-page":"1959","DOI":"10.1016\/j.cjca.2021.09.002","article-title":"Infertility, infertility treatment, and cardiovascular disease: an overview.","volume":"37","author":"Smith","year":"2021","journal-title":"Can J Cardiol"},{"issue":"6","key":"zoi250675r25","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1111\/1471-0528.17019","article-title":"Caesarean birth in women with infertility: population-based cohort study.","volume":"129","author":"Richmond","year":"2022","journal-title":"BJOG"},{"issue":"4","key":"zoi250675r26","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.7983","article-title":"Severe maternal morbidity and mental health hospitalizations or emergency department visits.","volume":"7","author":"Blackman","year":"2024","journal-title":"JAMA Netw Open"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2836835\/velez_2025_oi_250675_1752771009.58924.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T15:30:34Z","timestamp":1753457434000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2836835"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,25]]},"references-count":26,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.23428","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,25]]}}}