The Hidden Toll of Surrogacy on Women’s Mental Health

A new study finds that women who become gestational carriers are more likely to be diagnosed with a mental illness during or after pregnancy than those who conceive either naturally or through IVF.

Published July 25 in JAMA Network Open, the large Ontario-based analysis highlights gaps in mental health screening and follow-up care for surrogates, despite existing guidelines. Nearly 1 in 5 gestational carriers had a prior mental illness diagnosis, and their rate of new-onset psychiatric conditions was significantly higher than in other mothers, particularly when mental health issues required emergency or inpatient care.

What the Research Found

Drawing on health data from over 767,000 births in Ontario between 2012 and 2021, researchers identified just 758 births via gestational carriers, yet these women stood out:

• They experienced 6.9 new mental illness diagnoses per 100 person-years, compared to 5.2 for unassisted pregnancies and 5.0 for IVF.
• They had a 1.43 times higher adjusted risk than women who conceived without assistance.
• The risk was even greater for mental illnesses diagnosed through emergency departments or hospitalizations, not just outpatient visits.

“Unfortunately, fewer than half of those who visit the emergency room for mental health concerns after childbirth receive timely follow-up care, which leaves many, especially gestational carriers, at risk during a vulnerable period,” said study lead Dr. Maria Velez of McGill University and ICES.

Who Are Gestational Carriers?

Unlike traditional surrogates, gestational carriers have no genetic link to the child. They carry embryos created from the intended parents’ or donors’ egg and sperm. In this study, gestational carriers were more likely than other mothers to:

• Be older (average age 33.2 years)
• Have already had at least one child (91.2%)
• Live in lower-income neighborhoods
• Have higher rates of obesity (36.1%) and chronic hypertension (3.2%)

Despite formal requirements for mental health evaluation before pregnancy, 19% of gestational carriers had a documented mental illness prior to conceiving—a group that may not have been eligible under stricter screening.

Why Might Surrogates Be at Greater Risk?

The emotional and psychological demands of surrogacy are unique. From separation from the newborn to navigating relationships with the intended parents and dealing with societal judgment, the experience can be complex.

While earlier reviews of surrogate mental health were inconclusive due to small sample sizes and limited follow-up, this new population-based study offers robust, long-term data. Median follow-up spanned 4.5 years, and mental illness diagnoses were tracked for up to March 2024.

“Some gestational carriers may experience grief from relinquishing the newborn, such as that described after adoption or removal of a child into foster care,” the authors noted.

A Call for Better Mental Health Support

The study’s authors recommend enhancing mental health screening and extending support services throughout pregnancy and the years after birth. They also highlight the need for timely psychiatric care when issues emerge.

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

Mental health complications among surrogates could be preventable, the study suggests, with better counseling, closer monitoring, and postnatal care tailored to their unique experience.

Why This Study Matters Now

As surrogacy becomes more common, particularly among families facing infertility or LGBTQ+ parents, understanding the mental health implications for carriers is essential. This study provides the strongest evidence yet that surrogacy carries emotional risks—risks that healthcare systems must recognize and respond to.

Journal: JAMA Network Open

DOI: 10.1001/jamanetworkopen.2025.23428