{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T23:23:00Z","timestamp":1767914580324,"version":"3.49.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"7-8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Individuals seeking a gestational surrogate often turn to U.S. military dependents due to favorable insurance coverage. Surrogate pregnancies, including multiple gestations, may be at increased risk for adverse outcomes. The objectives of this study were to determine the incidence of surrogacy in a twin population conceived by assisted reproductive technology (ART), assess the impact on the military healthcare system, and determine if there is an increased rate of complications in twin surrogacy pregnancies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We conducted a 10-year retrospective cohort study of ART-conceived twin gestations at two military hospitals. Charts were reviewed for demographic data, surrogacy status, and obstetric complications. Number of prenatal visits and formal sonograms were tabulated for surrogate pregnancies. Complication rates were compared between groups using Fisher\u2019s exact test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Over the 10-year period, 36 of the 249 pregnancies were identified as gestational surrogates, equating to a rate of 14.4%. Surrogate mothers were younger than non-surrogates (29.58\u2009years vs. 33.11\u2009years, P\u2009&amp;lt;\u2009.001). Care of surrogate pregnancies required a total of 306 prenatal visits and 98 formal ultrasounds. The incidence of gestational diabetes was higher among surrogates compared to other ART-conceived twin pregnancies at 27.8% vs. 12.2% (P\u2009&amp;lt;\u2009.05), while other complications did not significantly differ.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Approximately one in seven ART-conceived twin gestations were surrogacy pregnancies, requiring significant clinical resources. The incidence of gestational diabetes was higher among surrogate gestations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usab386","type":"journal-article","created":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T18:17:41Z","timestamp":1644430661000},"page":"e2525-e2529","source":"Crossref","is-referenced-by-count":2,"title":["Incidence and Implications of Twin Gestational Surrogacy at Two Large U.S. Military Hospitals: A 10-Year Retrospective Cohort Study"],"prefix":"10.1093","volume":"188","author":[{"given":"Elizabeth B","family":"Osmundsen","sequence":"first","affiliation":[{"name":"School of Medicine, Uniformed Services University , Bethesda, MD 20889, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle M","family":"Shaw-Williams","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery and Obstetrics, Naval Medical Center Portsmouth , Portsmouth, VA 23708, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica A","family":"Lutgendorf","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery and Obstetrics, Naval Medical Center San Diego , San Diego, CA 92134, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5545-7361","authenticated-orcid":false,"given":"Andrew S","family":"Thagard","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery and Obstetrics, Naval Medical Center Portsmouth , Portsmouth, VA 23708, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"issue":"4","key":"2023072301082658800_R1","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.ajog.2020.01.037","article-title":"Understanding gestational surrogacy in the United States: a primer for obstetricians and gynecologists","volume":"222","author":"Swanson","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"2023072301082658800_R2","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/6287507.","article-title":"Risks in surrogacy considering the embryo: from the preimplantation to the gestational and neonatal period","volume":"2018","author":"Simopoulou","year":"2018","journal-title":"Biomed Res Int"},{"issue":"3","key":"2023072301082658800_R3","doi-asserted-by":"crossref","first-page":"e97","DOI":"10.1097\/AOG.0000000000001352","article-title":"ACOG Committee Opinion No. 660: family building through gestational surrogacy","volume":"127","author":"American College of O, Gynecologists\u2019 Committee on E","year":"2016","journal-title":"Obstet Gynecol"},{"issue":"1","key":"2023072301082658800_R4","doi-asserted-by":"crossref","first-page":"33","DOI":"10.5694\/mja15.00166","article-title":"Compensated transnational surrogacy in Australia: time for a comprehensive review","volume":"204","author":"Newson","year":"2016","journal-title":"Med J Aust"},{"issue":"12","key":"2023072301082658800_R5","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1016\/j.jogc.2018.08.005","article-title":"Canada\u2019s prohibition on payment for surrogacy, eggs, and sperm","volume":"40","author":"Baylis","year":"2018","journal-title":"J Obstet Gynaecol Can"},{"issue":"5","key":"2023072301082658800_R6","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1089\/jwh.2017.6540","article-title":"Outcomes for gestational carriers versus traditional surrogates in the United States","volume":"27","author":"Fuchs","year":"2018","journal-title":"J Womens Health"},{"key":"2023072301082658800_R7","article-title":"Assembly Bill No. 1217 surrogacy agreements","author":"California Legislative Information","year":"2012"},{"key":"2023072301082658800_R8","article-title":"\u00a7 20-160. 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