Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. Nov 10, 2015; 4(4): 102-107
Published online Nov 10, 2015. doi: 10.5317/wjog.v4.i4.102
Outcomes of surrogate pregnancies in California and hospital economics of surrogate maternity and newborn care
Yona Nicolau, Austin Purkeypile, T Allen Merritt, Mitchell Goldstein, Bryan Oshiro
Yona Nicolau, Austin Purkeypile, T Allen Merritt, Mitchell Goldstein, Bryan Oshiro, Department of Pediatrics, Division of Neonatology, Loma Linda University Children’s Hospital, Loma Linda, CA 92354, United States
Yona Nicolau, Austin Purkeypile, T Allen Merritt, Mitchell Goldstein, Bryan Oshiro, Department of Obstetrics and Gynecology, Loma Linda University Children’s Hospital, Loma Linda, CA 92354, United States
Yona Nicolau, Austin Purkeypile, T Allen Merritt, Mitchell Goldstein, Bryan Oshiro, Office of Finance, Loma Linda University Children’s Hospital, Loma Linda, CA 92354, United States
Author contributions: Nicolau Y designed research, performed research, analyzed data and wrote the paper; Purkeypile A designed research, performed research and contributed to analytic tools; Merritt TA designed research, performed research, analyzed data and wrote the paper; Goldstein M designed research, performed research and analyzed data; Oshiro B designed research, performed research and wrote the paper.
Institutional review board statement: The research was approved by the Institutional Review Board of Loma Linda University School of Medicine.
Informed consent statement: Written Informed consent was waived by Institutional Review Board of Loma Linda School of Medicine.
Conflict-of-interest statement: The authors declare not conflicts of interest.
Data sharing statement: The data contained in this manuscript has been approved for this use and cleared by all concerned parties.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yona Nicolau, MD, Department of Pediatrics, Division of Neonatology, Loma Linda University Children’s Hospital, 11175 Campus St, Coleman Pavilion 11121, Loma Linda, CA 92354, United States. ynicolau@llu.edu
Telephone: +1-909-5587448 Fax: +1-909-5580298
Received: March 26, 2015
Peer-review started: March 28, 2015
First decision: June 3, 2015
Revised: June 15, 2015
Accepted: August 4, 2015
Article in press: August 7, 2015
Published online: November 10, 2015
Abstract

AIM: To describe maternity and newborn charges for an economic analysis of surrogate pregnancies on the health care resource utilization.

METHODS: A retrospective chart review of all women identified as being surrogates and the infants born from these pregnancies was performed between January 1, 2012 and December 31, 2013. Selected maternity diagnoses, mode of delivery, duration of hospitalization, and hospital charges were collected together with infants’ birth weights, gestational age, length of hospital stay, and hospital charges. Charges associated with the in vitro fertilization cycles, artificial insemination, or embryo(s) transfer into the surrogate were not considered in the maternity charges. A ratio contrasting the maternity hospital charges for the surrogate carrier was compared as a ratio to the mean charges for 2540 infants delivered in 2013 after natural conception and adjusted to the baseline hospital charges for both maternity and newborn care.

RESULTS: Analysis of sixty-nine infants delivered from both gestational and traditional surrogate women found an increased in multiple births, NICU admission, and length of stay with hospital charges several multiples beyond that of a term infant conceived naturally and provided care in our nursery. Among singletons and twins (per infant) hospital charges were increased 26 times (P < 0.001) and in triplets charges were increased 173 times (P < 0.0001) when compared to a term infant provided care in a normal nursery at our center.

CONCLUSION: Maternity costs for surrogates exceed those of women who conceive naturally, and these costs are especially magnified in women with triplets and multiple births.

Keywords: Surrogacy pregnancy, Assisted reproductive technologies, Prematurity, Multiple gestations

Core tip: Surrogate pregnancies result in higher maternity and newborn costs with increased rates of multiple births and creates a moral hazard for hospitals. This increase occurs despite of the fact that surrogate mothers are prescreened for health and reproductive ability. Reduction in multiple embryo transfer would reduce the adverse economic impact of surrogate pregnancy, maternity and newborn costs.