Can You Be a Surrogate If You Had Preeclampsia or Gestational Diabetes?

These are two of the most common pregnancy complications, and two of the most common reasons women hesitate to apply. A past diagnosis is a question your history has to answer, not an automatic no. Here's how that question usually gets answered.

Published October 9, 2026

It depends on the details: a history of preeclampsia or gestational diabetes is usually reviewed case by case rather than treated as an automatic no, and clinics look at how severe it was, when it started, how it was treated and how your most recent pregnancy went. A mild, late or diet-controlled complication that fully resolved after delivery is viewed very differently from early, severe preeclampsia, HELLP syndrome, or blood sugar problems that continued after the baby was born.

We've written before about why agencies ask for a prior uncomplicated pregnancy. This piece goes deeper on the two complications we hear about most on screening calls, because the word "complication" covers a very wide range, and the details are what decide your answer.

Where the standard comes from

ASRM, the American Society for Reproductive Medicine, says in its practice guidance that, ideally, a carrier should have had at least one term, uncomplicated pregnancy before carrying for someone else, and its ethics guidance says carriers should have had at least one uncomplicated pregnancy. Neither lists specific diagnoses, so each clinic decides how a past complication fits that standard. ASRM's ethics guidance also says that carriers and intended parents should think through, in advance, how complications such as preeclampsia would be managed. Clinics take that seriously because a surrogacy pregnancy is still your pregnancy, with your body carrying the risk.

Preeclampsia: what clinics want to know

Preeclampsia is high blood pressure in pregnancy with signs that other organs are under strain. It ranges from mild, near-term cases that resolve after delivery to severe, early cases that can be dangerous for mother and baby. A reviewing doctor will usually ask:

• How early it started. Preeclampsia near your due date is a very different history from preeclampsia that forced a delivery months early.
• How severe it was. Whether you needed blood pressure medication, magnesium, an early delivery or intensive care, and whether it progressed to HELLP syndrome, a severe form involving the liver and blood clotting.
• Whether it happened more than once. One episode followed by a clean pregnancy reads very differently from a repeated pattern.
• Your blood pressure now. Pressure that returned to normal after delivery matters. Ongoing high blood pressure is a separate question.

Timing and severity matter because they predict whether it comes back. A large 2026 US study of more than 560,000 patients with two or more pregnancies found that about 15 percent of people with a severe blood pressure disorder in one pregnancy had a severe one again in the next, rising to roughly 23 percent when the first episode began before 28 weeks. That's one reason clinics look hardest at early, severe histories.

You may also see aspirin come up. The US Preventive Services Task Force recommends low-dose aspirin, 81 mg a day after 12 weeks of pregnancy, for people at high risk of preeclampsia, and a prior history of preeclampsia is one of the risk factors it lists. In a surrogacy pregnancy, that's a decision for the doctors caring for you. Never start, stop or change a medication on your own.

Gestational diabetes: what clinics want to know

Gestational diabetes is common. The CDC says it affects 5 to 9 percent of US pregnancies each year, and having it in one pregnancy is a risk factor for having it again. For a carrier candidate, the questions are usually:

• How it was managed. Diet and exercise alone, oral medication, or insulin. Diet-controlled gestational diabetes is often viewed more favorably than gestational diabetes that needed insulin, but programs differ.
• Whether it went away. The CDC notes that about half of women with gestational diabetes go on to develop type 2 diabetes. Clinics will want to know your blood sugar is normal now, and some ask for a recent A1C or glucose test.
• How the baby and delivery went. A very large baby, a difficult delivery or a complication tied to blood sugar all get a closer look.

Diabetes that existed before pregnancy, or that didn't resolve after delivery, is a different situation from gestational diabetes and is often a barrier to carrying for someone else.

Your most recent pregnancy carries a lot of weight

If your first pregnancy had preeclampsia or gestational diabetes and your second was uneventful, many reviewers give the second one more weight, because it's the most recent evidence of how your body handles pregnancy now. The reverse is also true: a complication in your most recent pregnancy usually gets the closest look.

An honest word about your own health

Being told a past complication rules you out can feel like a verdict on your body. It isn't. A program that declines an early, severe preeclampsia history is protecting you, because a surrogacy pregnancy carries the same kinds of risks as your own pregnancies did. ASRM's guidance asks that carriers be counseled about potential pregnancy complications, and that's a conversation worth having with your own OB too, especially if your blood pressure or blood sugar has needed attention since. If the answer is yes, you go in clear-eyed. If it's no, you haven't lost anything by asking.

The psychological evaluation will also ask how you've processed a hard pregnancy. ASRM lists unresolved issues from a traumatic pregnancy, labor or delivery among its reasons a candidate may be declined, so it's worth being honest with yourself about how that experience sits with you now.