Is Surrogacy Safe? What New 2026 Research Says About Surrogate Pregnancy Risks
- ACRC Global
- 5 hours ago
- 9 min read
Is surrogacy safe for the woman carrying the pregnancy? The most accurate answer is that gestational surrogacy can be a safe family-building option, but no pregnancy is entirely without risk. A new U.S. study published in June 2026 offers encouraging findings: compared with other IVF pregnancies, surrogate pregnancies were not associated with a higher adjusted risk of preterm birth, placenta previa or placental abruption. Researchers also observed lower adjusted risks for several other pregnancy complications.
These results add valuable information to the ongoing study of gestational surrogacy. They do not guarantee a particular outcome, replace individualized medical advice or remove the need for comprehensive screening and prenatal care.
If you are considering surrogacy and want to understand the process, professional team involved and next steps, schedule a free consultation with ACRC Surrogacy.
What Did the New 2026 Surrogacy Study Examine?
The study, “Adverse Perinatal Outcomes by Gestational Surrogacy Status among In Vitro Fertilization Pregnancies,” was published online in the American Journal of Perinatology on June 22, 2026.
Researchers reviewed electronic health records from Kaiser Permanente Southern California covering 2008 through 2023. The study included:
15,822 IVF pregnancies
997 surrogate pregnancies, representing 6.3% of the study group
Patients who received obstetric care within a large integrated Southern California healthcare system
The researchers compared selected pregnancy outcomes in surrogate and non-surrogate IVF pregnancies. They then adjusted their analysis for factors that could affect risk.
What Did Researchers Find About Surrogate Pregnancy Risks?
The study did not find a statistically significant increase in three outcomes among the surrogate pregnancies studied:
Pregnancy outcome | Finding in the 2026 study |
Preterm birth | No increased adjusted risk identified |
Placenta previa | No increased adjusted risk identified |
Placental abruption | No increased adjusted risk identified |
Researchers also reported lower adjusted risks of the following selected outcomes among surrogate pregnancies compared with non-surrogate IVF pregnancies:
Gestational diabetes
Preeclampsia or eclampsia
Small for gestational age or intrauterine growth restriction
Preterm premature rupture of membranes
Chorioamnionitis, an infection involving the membranes surrounding the baby
These findings are encouraging, particularly because the study included nearly 1,000 surrogate pregnancies. However, “lower risk” in a retrospective study does not mean “no risk,” nor does it establish that surrogacy itself caused the differences.
Does This Study Prove That Gestational Surrogacy Is Risk-Free?
No. Every pregnancy carries potential medical risks, including pregnancies carried by women who have previously had uncomplicated births.
The 2026 study also has important limitations:
It was observational and retrospective, so it can identify associations but cannot prove cause and effect.
It examined patients within one Southern California healthcare system, which may limit how broadly the results apply.
Pregnancies ending before 20 weeks were excluded, so the study did not evaluate early pregnancy loss.
Screening practices, embryo-transfer decisions, prenatal care and individual health factors may differ among fertility clinics and surrogacy programs.
The safest interpretation is that the study contributes reassuring new evidence about several measured outcomes, while further research is still needed.
Why Have Other Surrogacy Studies Reported Different Results?
Not every study has reached the same conclusion. A 2024 population-based study from Ontario, Canada, examined 806 gestational-carrier pregnancies and reported higher rates of severe maternal morbidity and certain pregnancy complications than in pregnancies conceived with and without IVF.
Different results do not automatically mean that one study is right and another is wrong. Surrogacy research may vary because studies examine different:
Countries and healthcare systems
Patient populations and time periods
Singleton and multiple pregnancies
Comparison groups
Medical outcomes
Screening and prenatal-care practices
Statistical adjustments and available health information
The 2026 U.S. study compared surrogate pregnancies specifically with other IVF pregnancies within one healthcare system. The Canadian study compared gestational-carrier pregnancies with both unassisted and IVF pregnancies across Ontario. These differences matter when interpreting the findings.
Together, the studies reinforce an important point: surrogate health should remain central throughout every journey.
How Are Potential Surrogates Screened Before Pregnancy?
The medical screening process is designed to determine whether pregnancy may be appropriate for a particular applicant. Final medical eligibility is determined by a qualified fertility physician not by a surrogacy agency alone.
The American Society for Reproductive Medicine’s recommendations for practices using gestational carriers state that a potential surrogate should preferably be between 21 and 45 years old and should ideally have experienced at least one full-term, uncomplicated pregnancy.
ASRM also recommends a process that may include:
Review of medical and pregnancy history
Physical and preconception evaluation
Infectious-disease screening and testing
Uterine-cavity evaluation
Psychosocial assessment and counseling
Independent legal counseling
Education about medications, embryo transfer and pregnancy risks
Individual fertility clinics may apply additional requirements based on a candidate’s health history and their medical protocols.
How Does ACRC Surrogacy Screen Surrogate Candidates?
ACRC Surrogacy uses a multi-stage process to help determine whether an applicant may be ready to move forward. The purpose is to protect the surrogate’s well-being, give intended parents reliable information and ensure that qualified professionals review the areas within their authority.
1. Initial eligibility review
Under ACRC’s current general guidelines, a surrogate candidate typically must:
Be between 21 and 38 years old
Be a U.S. citizen or permanent resident living in the United States
Live in a state where the proposed surrogacy journey can legally proceed
Have experienced at least one healthy, full-term pregnancy and delivery
Be in good physical and emotional health
Have a stable home environment and a dependable support system
Be willing to complete the required medical, psychological, background and legal screening
These are initial guidelines, not a guarantee of approval. Eligibility can depend on medical history, pregnancy records, clinic requirements, applicable law and the circumstances of the individual journey.
2. Application and intake interview
The candidate completes an application and speaks with an ACRC intake professional. This stage helps the team understand her pregnancy history, current health, motivation, support system, availability and expectations for a surrogacy journey. It also gives the applicant an opportunity to ask questions before moving further into the process.
3. Pregnancy-record and background review
4. Clinic-led medical screening
After the initial ACRC review, surrogates are matched with intended parents then the treating fertility clinic completes its own evaluation. Depending on the clinic and individual circumstances, this may include laboratory testing, infectious-disease screening, physical or preconception evaluation and assessment of the uterine cavity.
The fertility physician—not ACRC—makes the final decision about medical eligibility, embryo-transfer preparation and treatment. Passing ACRC’s initial screening therefore does not guarantee medical clearance.
5. Psychological evaluation and informed preparation
After matching with an intended parent a potential surrogate may complete an evaluation with a qualified mental health professional experienced in third-party reproduction. The evaluation can explore emotional readiness, family support, communication, expectations, pregnancy-related decisions and the possible effect of the journey on the surrogate and her household.
6. Matching and independent legal review
Screening also involves determining whether the surrogate and intended parents are mutually comfortable with the proposed match. ACRC helps facilitate communication so both parties can consider their expectations before choosing whether to proceed.
Before fertility treatment begins, the surrogate and intended parents should receive advice from separate, independent attorneys. The attorneys—not the agency—explain legal rights and obligations and negotiate the surrogacy agreement for their respective clients.
7. Continued coordination and support
Screening is not the end of ACRC’s involvement. After a match, the agency continues coordinating communication and practical milestones with the surrogate, intended parents, fertility clinic and independent professionals. The treating medical providers remain responsible for medical decisions throughout treatment and pregnancy.
Why Does a Previous Healthy Pregnancy Matter?
A previous uncomplicated pregnancy provides physicians with meaningful information about how a potential surrogate’s body has responded to pregnancy and delivery in the past. It does not predict the future with certainty, but it can help the medical team evaluate factors such as:
Pregnancy and delivery history
Previous cesarean deliveries
Hypertensive disorders or gestational diabetes
Preterm birth
Postpartum recovery
Other obstetric complications
This is one reason reputable surrogacy programs do not treat screening as a simple application checklist. Medical records must be reviewed by the appropriate professionals before a candidate can receive medical clearance.
What Role Does a Surrogacy Agency Have in a Safer Journey?
A surrogacy agency does not replace the fertility physician, obstetrician, mental health professional or independent attorney. Its role is to help coordinate the people, information and milestones involved in a complex journey.
Professional agency support may include:
Initial surrogate qualification and records collection
Coordination with fertility clinics during medical screening
Support during matching and communication
Coordination with independent legal and insurance professionals
Assistance with timelines, appointments and journey milestones
Ongoing support for the surrogate and intended parents
Preparation for pregnancy, delivery and post-birth logistics
This coordination cannot eliminate pregnancy risks. It can, however, help ensure that important steps are not treated casually and that intended parents and surrogates know which qualified professional should answer each question.
What Should Intended Parents Ask a Surrogacy Agency?
When comparing agencies, intended parents may wish to ask:
How are potential surrogates initially qualified?
Who provides final medical clearance?
What psychological evaluation and counseling are required?
Does each party receive independent legal representation?
How are medical records and pregnancy histories reviewed?
How does the agency coordinate with the fertility clinic?
What support is available during pregnancy and after delivery?
How are urgent concerns or communication challenges handled?
Clear answers can help intended parents understand whether an agency has a structured, transparent and surrogate-centered process.
What Should Potential Surrogates Ask Before Applying?
Women considering surrogacy should have the opportunity to ask detailed questions before making any commitment, including:
What medical testing will I complete?
Who makes decisions about my medical care?
Will I have my own independent attorney?
What pregnancy-related risks should I discuss with the fertility physician and my obstetrician?
What emotional support is available before, during and after pregnancy?
How will pregnancy-related expenses, insurance and lost wages be handled?
What happens if complications occur?
Informed consent means having time to understand the medical, emotional, legal and practical aspects of the journey—not simply signing documents.
Women interested in learning about ACRC's initial qualifications and support can review the requirements to become a surrogate.
Frequently Asked Questions About Surrogacy Safety
Is surrogacy safe for the surrogate?
Gestational surrogacy can be a safe option for appropriately screened candidates, but every pregnancy carries potential risks. A new 2026 U.S. study did not identify higher adjusted risks of preterm birth, placenta previa or placental abruption among the surrogate pregnancies studied. Individual risk must still be evaluated by qualified medical professionals.
Does being a surrogate increase the risk of preterm birth?
The 2026 Southern California study did not find an increased adjusted risk of preterm birth compared with other IVF pregnancies. However, earlier research from Canada reported a higher risk. Differences in study design and patient populations mean additional research is needed.
Can a woman become a surrogate if she has never been pregnant?
Reputable U.S. programs generally require a potential surrogate to have previously delivered a child. ASRM recommends that a surrogate should ideally have experienced at least one full-term, uncomplicated pregnancy.
Who decides whether a surrogate is medically eligible?
A qualified fertility physician or clinic provides final medical clearance after reviewing the candidate’s health and pregnancy history and completing the required evaluation. An agency can perform initial qualification and coordinate records, but it should not replace the physician’s decision.
Can screening guarantee a complication-free pregnancy?
No. Screening helps medical professionals identify known risk factors, but it cannot predict or prevent every possible pregnancy complication.
Why is independent legal representation important?
The intended parents and surrogate have different rights and responsibilities. Separate attorneys can help each party understand the agreement and receive advice focused on their own interests. Legal requirements vary by state.
The Bottom Line: What Does the 2026 Study Mean for Families?
The new research offers encouraging evidence about several pregnancy outcomes among gestational surrogates receiving care in a large Southern California health system. It found no increased adjusted risk of preterm birth, placenta previa or placental abruption and reported lower adjusted risks for several other measured complications.
It does not prove that every surrogate pregnancy will be uncomplicated. The study should be understood alongside other research, including studies that have identified increased risks. Thoughtful screening, informed consent, qualified medical care and coordinated support therefore remain essential.
For intended parents, choosing surrogacy is not simply about finding someone willing to carry a pregnancy. It is about building a professional team that respects the surrogate’s health, rights and well-being while guiding everyone through each stage responsibly.
Speak With ACRC Surrogacy
ACRC Surrogacy helps intended parents understand the U.S. surrogacy process and coordinates with the medical, legal, insurance and support professionals involved in each journey.
If you are exploring surrogacy or comparing programs, book a free consultation with ACRC Surrogacy. Our team can discuss your goals, explain the process and help you identify the appropriate next steps.
Important notice:
Disclaimer:
This article is provided for general educational purposes and does not constitute medical, legal, insurance or financial advice. Research findings describe study populations and cannot predict an individual pregnancy outcome. Intended parents and potential surrogates should consult qualified professionals regarding their circumstances.
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