Obstetric cholestasis and surrogacy

[kavii]

Hi,

I am considering being a surrogate for my sister in low and her husband but I had obstetric cholestasis when pregnant with my son. Does it disqualify me from being a surrogate?

Thanks for your help

I was told it would by a midwife, but didn't look into it in any more depth.

Hi there. There is no research into surrogacy and ICP (also known as OC) but there are a couple of things to consider. If someone is a surrogate and they have had ICP but carries an embryo isn't biologically then they may still develop ICP in any pregnancy that results. If someone who has had ICP is considering being a surrogate using their own egg then there is a risk of transferring their own genetics for ICP to the baby. I work in research into the condition and was recently asked this question in the support group of the charity I am CEO (ICP Support) for and so was able to check with my professor about this.

Ex midwife here.
You would be very foolish and ill advised if you did this. I am sure you must have been to,d at the time of your first pregnancy that there is a high chance of this happening in future pregnancies.
You will be risking your own health and also that of the baby, as you must know there is a higher rate of still birth and premature birth in cases of obstetric cholestasis.
I am appalled that commissioning parents would be so selfish and unaware to use someone who has had this complication. Don't they want a healthy baby after all they have gone through to get one?
This will also impact the nhs, as you will require close monitoring, additional tests and if the baby is born early extra support for a premature baby. All quite unnecessarily.
Please be sensible and say no.

Just replying to the recent comment.

You are absolutely right that there is a high chance of developing ICP in another pregnancy, but by and large, ICP can be very well managed. Based on the most recent research by Ovadia et al ,(The Lancet Feb 2019) most women with ICP can be reassured about the safety of their babies, and should be able to wait until 39 weeks for induction (if they can cope with the itching until then that is!). It's the women whose bile acids rise above 100 micromol/L that need very close management as the risk of stillbirth rises from this level (and from around 35 weeks). And closer management actually only means regular bile acid tests as CTGs are not known to be of any benefit.

There is no real risk to the woman's health from ICP (for example her liver will not fail) but anyone who has the genetic changes for the condition will be at increased risk of developing gallstones and potentially conditions such as Type 2 diabetes (although this needs more research).

And ICP babies are healthy; it's those who are preterm and may need to spend time in the neonatal unit that need specialist care, but I would gently point out that quite a few hospitals are advising early births (and therefore an increased risk of a neonatal stay) when there is no need to do this.

I say all this based on the research work but I do also appreciate the risks given that I have also suffered stillbirth as a result of the condition, so what I write here I don't write lightly. Please do catch up with all the latest research on our website www.icpsupport.org

@kavii Reading my first reply back I can see that I missed a couple of words out and should have said that if the baby isn't biologically yours you may still develop ICP. I should also say that this is such a complex condition because I know someone who was a surrogate, had had 4 children with no problems, and developed ICP when she became a surrogate even though the baby she was carrying wasn't biologically hers (and why this happened can't be explained).

Itchy I'm very sorry you suffered loss through stillbirth and you have my deepest sympathy.

I do feel, however, that there is a big difference between a woman who has had this condition and who weighs up the risks to have another baby and a surrogate pregnancy. It Is reckless madness to choose to use a surrogate who has previously suffered this condition in my view. And very selfish, not caring about the mother having an uncomfortable and difficult pregnancy even if her health isn't compromised, taking risks with the health of the baby, and making increased demands on the health service.
Why would anyone do that?