Why You Should Do Early Pregnancy Scans

Recent studies shed light on the increased risks associated with gestational carriage (surrogacy) compared to other forms of conception.

A cohort study conducted in Ontario, Canada, analyzed over 860,000 births between 2012 and 2021, revealing that surrogate mothers are more likely to experience severe maternal complications, such as preeclampsia and postpartum hemorrhage.

The findings highlight the importance of enhanced monitoring and specialized care for gestational carriers. Early pregnancy scans are a vital component in this equation, offering a critical tool to identify potential complications and improve maternal and neonatal outcomes.

Increased Risks for Gestational Carriers

The study, published in the Annals of Internal Medicine, compared pregnancy outcomes across three groups: unassisted conception, pregnancies via in vitro fertilization (IVF), and gestational carriage.

Among gestational carriers, the rate of severe maternal morbidity (SMM) was 7.8%, significantly higher than the 2.3% for unassisted conception and 4.3% for IVF pregnancies. Key findings include:

• Higher Incidence of Complications:
  • Surrogates were nearly three times more likely to experience severe postpartum hemorrhage compared to women with unassisted conception.
    
  • They had a 1.8 times greater likelihood of preterm birth before 37 weeks compared to women who conceived through IVF.
    
• Underlying Factors:
  • Many surrogates had preexisting conditions such as obesity or high blood pressure, but these did not entirely explain the increased risks.
    
  • Immunological mechanisms might contribute to the higher rates of complications in gestational carriage.
    
• Ethical Considerations:
  • The findings raise ethical concerns about the health of surrogates, particularly if guidelines for selecting healthy candidates are not consistently followed.

The data underscores the need for tailored medical care plans for gestational carriers, beginning with early and comprehensive assessments during the first trimester.

The Role of Early Pregnancy Scans

Early pregnancy scans are a cornerstone of prenatal care, especially in pregnancies involving gestational carriers or assisted reproductive technologies (ART).

These scans, typically performed between 6-12 weeks of gestation, provide invaluable insights into maternal and fetal health.

Key Benefits of Early Pregnancy Scans

• Confirming Viability:
  • Early scans confirm the presence of a gestational sac, yolk sac, and fetal heartbeat, ensuring the pregnancy is progressing as expected.
    
  • This is particularly important in gestational carriage, where initial assessments reassure both the surrogate and intended parents.
    
• Identifying Multiple Pregnancies:
  • IVF and ART pregnancies have a higher likelihood of multiples. Early scans help detect twins or higher-order multiples, enabling clinicians to plan for additional care needs.
    
• Diagnosing Ectopic Pregnancies:
  • Ectopic pregnancies, where the embryo implants outside the uterus, pose a serious risk to the mother. Early scans ensure timely diagnosis and intervention.
    
• Monitoring Uterine and Placental Health:
  • Surrogates are at increased risk of placenta previa and other placental abnormalities. Early scans can identify these issues, allowing for close monitoring throughout the pregnancy.
    
• Predicting Preterm Birth:
  • By assessing cervical length and uterine conditions, early scans can identify women at risk for preterm labor, enabling preventative measures to reduce neonatal morbidity.

Addressing Risks Through Enhanced Care

The higher risks associated with gestational carriage call for a comprehensive approach to prenatal care, incorporating both public health policies and individualized medical attention.

Specialized Care Plans for Surrogates

• Frequent Monitoring:
  
  • Regular scans and prenatal check-ups help detect complications early, reducing the likelihood of severe outcomes.
    
  • Surrogates may benefit from more intensive monitoring schedules, particularly if they have underlying health conditions.
    
• Collaborative Care:
  
  • Private gynaecology services can complement public healthcare, providing faster access to diagnostic tools and personalized treatment plans.
    
  • Clinics offering private scans and consultations can alleviate the pressure on NHS waiting lists, ensuring timely care for gestational carriers.
    
• Comprehensive Education:
  
  • Surrogates should be fully informed about the potential risks associated with their pregnancies, including the importance of early scans and follow-up appointments.

The Ethical Dimension

The findings of this study raise critical ethical questions about the selection and care of gestational carriers. Many surrogates may enter these arrangements with previous healthy pregnancies but face unexpected complications during surrogacy. This highlights the need for:

• Stricter Guidelines:
  
  • Ensuring surrogates meet health criteria to minimize risks.
    
• Improved Data Collection:
  
  • Expanding research on surrogate pregnancies to better understand risks and outcomes.
    
• Equitable Care Access:
  
  • Providing surrogates with the same level of care as other pregnant women, regardless of socioeconomic status.

Early Scans: A Tool for All Pregnancies

While gestational carriers face unique risks, early pregnancy scans are invaluable for all expectant mothers. For example:

• Women with high-risk pregnancies, such as those with fibroids or previous cesarean sections, can benefit from early detection of complications.
  
• Clinics offering private early pregnancy scans provide an essential option for women seeking immediate reassurance and care, reducing anxiety during the first trimester.

Conclusion

The study on gestational carriage underscores the importance of addressing risks associated with surrogate pregnancies through enhanced care and early interventions.

Early pregnancy scans play a pivotal role in ensuring maternal and fetal wellbeing, offering critical insights that guide care plans and improve outcomes.

For surrogates and all pregnant women, access to timely and comprehensive care—whether through public services or private gynaecology clinics—is essential.

By prioritizing early assessments and fostering collaboration between healthcare providers, we can better support all women through the challenges of pregnancy and ensure healthier outcomes for mothers and babies alike.