This systematic review compared obstetric outcomes in gestational surrogacy (GS, using donor egg) vs. traditional surrogacy (TS, using the surrogate's own egg) and vs. the surrogate's own spontaneous conceptions (SC) in singleton pregnancies, searching four databases through October 2024.
Eight studies were included (four GS vs. TS; four TS vs. SC). GS vs. SC showed significantly higher rates of pre-eclampsia/gestational hypertension (RR 2.39, 95% CI 1.15–4.49), gestational diabetes (RR 4.68, 95% CI 1.53–14.25), and preterm birth (RR 3.18, 95% CI 1.64–6.14); GS vs. TS results were imprecise due to small study sizes.
- Only eight small studies qualified, making GS vs. TS comparisons underpowered and imprecise. - Full text extraction failed (PDF pages were blank); conclusions rely entirely on the abstract and results sections. - Twin pregnancies were not analyzed separately, limiting generalizability.
Clinicians counseling surrogates and intended parents should discuss that gestational surrogacy (donor egg) carries roughly 2–5× higher risk of pre-eclampsia, gestational diabetes, and preterm birth compared to the surrogate's own conceptions. Until more direct GS vs. TS data exist, informed consent should explicitly address these elevated maternal and neonatal risks.
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