The hidden losses of surrogacy to women’s mental health

A new study found that women who are naturally pregnant or through IVF are more likely to be diagnosed with mental illness during or after pregnancy.

Released on July 25 JAMA Network Opena large Ontario-based analysis highlights the gap in mental health screening and follow-up to agents in Ontario despite the guidelines. One in five pregnant carriers suffer from previous mental illness diagnoses and their new mental illness rate is significantly higher than other mothers, especially when mental health problems require emergency or hospitalization.

What has the research found

Using health data from more than 767,000 births in Ontario, the researchers identified 758 births through pregnancy vectors alone, but these women stood out:

• They experienced 6.9 new mental illness diagnoses every 100 people years, compared with 5.2 for helpless pregnancy and 5.0 for IVF.
• Their adjustment risk is 1.43 times that of women who do not help.
• Mental illness diagnosed through emergency departments or inpatients is not just outpatient visits, but has greater risks.

“Unfortunately, less than half of the emergency rooms that visited the emergency room after delivery received timely follow-up care, which puts many people in a vulnerable period,” said Dr. Maria Velez, who led the research team at McGill University and ICES.

Who is the pregnancy carrier?

Unlike traditional alternatives, pregnancy vectors have no genetic link with children. They carry embryos produced by eggs and sperm from scheduled parents or donors. In this study, pregnancy vectors were more likely than other mothers:

• Older (average age of 33.2 years old)
• Have at least one child (91.2%)
• Living in a low-income community
• Higher obesity rates (36.1%) and chronic hypertension (3.2%)

Despite formal requirements for mental health assessments before pregnancy, 19% of pregnant carriers suffer from recorded mental illness prior to conception, a group that may not be eligible for stricter screenings.

Why are agents likely to face greater risks?

The emotional and psychological requirements of surrogacy are unique. From newborns to relationships with pre-determined parents and the separation of social judgments, experience can be complex.

Although early comments on alternative mental health are inconclusive due to small sample sizes and limited follow-up, this new population-based study provides strong long-term data. The median follow-up time was 4.5 years, and a mental illness diagnosis was performed in March 2024.

“Some pregnancy vectors may feel sad about giving up newborns, such as in pregnancy vectors described after adoption or deletion of the child,” the author noted.

Call for better mental health support

The authors of the study recommend enhancing mental health screening and expanding support services throughout the pregnancy and postnatal years. They also highlighted the need for timely psychiatric care when problems arise.

In Ontario, about 45% of people with new onset mental illness use the emergency room as their first point of contact, but many do not receive adequate follow-up care, especially for postpartum women’s gap.

The study shows that mental health complications between surrogates can be prevented and postpartum care can be tailored to their unique experience through better consultation, more careful monitoring and postpartum care tailored to their unique experience.

Why this study is important now

As surrogacy becomes more common, especially in families facing infertility or LGBTQ+ parents, understanding the mental health effects on the carrier is crucial. This study provides the strongest evidence that surrogacy carries emotional risks, the risks that healthcare systems must recognize and respond to.

Magazine: JAMA Network Open

doi: 10.1001/jamanetworkopen.2025.23428

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