- Design
- Matched population cohort, administrative data from three Canadian provinces
- Population
- 385 pregnancies in 252 living kidney donors vs 1540 matched non-donor pregnancies
- Primary outcome
- Hospitalisation with gestational hypertension, pre-eclampsia or eclampsia
- Effect
- 11.9% vs 8.3%; risk ratio 1.51 (95% CI 1.10 to 2.08)
This Canadian matched cohort used administrative data from three provinces. It compared 385 pregnancies in 252 women who had donated a kidney with 1540 matched pregnancies in non-donors, matched on age, timing, parity and income.
Hospitalisation with gestational hypertension, pre-eclampsia or eclampsia occurred in 11.9% of donor pregnancies and 8.3% of non-donor pregnancies (risk ratio 1.51, 95% CI 1.10 to 2.08). Small-for-gestational-age birth was also more common (13.8% against 7.9%, risk ratio 1.86). Most pregnancies after donation were uncomplicated.
This matters in India, where most living kidney donors are women, many of childbearing age. It supports telling potential donors about this risk before donation, and treating a pregnancy after donation as one that warrants closer blood pressure and growth monitoring. It is an association, and the numbers of events are modest.
- Discuss the raised risk of pre-eclampsia with women considering kidney donation who may want children.
- Record kidney donation in the antenatal history.
- Consider closer blood pressure and fetal growth monitoring in pregnancies after donation.
- Reassure that most pregnancies after donation were uncomplicated.
Why it matters
Donor counselling in India rarely covers future pregnancy, yet many donors are young women.
Don't overread it
An observational association; it cannot show donation itself caused the excess risk.
The statistics, in plain English
A risk ratio of 1.51 means about one and a half times the risk; in absolute terms, about 4 more affected pregnancies per 100. The confidence interval (1.10 to 2.08) excludes no effect but is wide because the numbers are small. Among 12 secondary outcomes only one stood out, which could partly be chance.
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