Pregnancy After Kidney Donation Linked to Higher Hypertensive-Disorder Risk

In a matched cohort study using Canadian administrative health data, researchers compared 385 pregnancies after living kidney donation with 1,540 matched pregnancies among nondonors. Hypertensive disorders requiring hospitalization and small-for-gestational-age birth were more frequent after donation, although most donor pregnancies were uncomplicated.

Hypertensive disorders requiring hospitalization: 11.9% vs 8.3%.
Small-for-gestational-age birth: 13.8% vs 7.9%.
Most pregnancies after donation were uncomplicated.

This matched cohort study used administrative health databases from Ontario, British Columbia, and Alberta. It included 385 singleton pregnancies of at least 20 weeks’ gestation among 252 living kidney donors aged 18 to 42 years, matched with 1,540 pregnancies among 1,535 nondonors. Matching accounted for delivery date, age, time between cohort entry and delivery, prior pregnancies, and income. The primary outcome was hospitalization with a diagnosis of gestational hypertension, preeclampsia, or eclampsia.

The primary outcome occurred in 46 donor pregnancies (11.9%) and 128 nondonor pregnancies (8.3%), for a risk ratio of 1.51 (95% CI, 1.10-2.08). Small-for-gestational-age birth was also more frequent after donation: 53 pregnancies (13.8%) versus 121 (7.9%; risk ratio, 1.86; 95% CI, 1.37-2.52). Among 12 secondary outcomes, this was the only other outcome whose risk-ratio confidence interval excluded 1.

The observational findings support discussing this risk with donor candidates who may become pregnant and informing prenatal care after donation. Most postdonation pregnancies were uncomplicated. The study was limited to pregnancies reaching at least 20 weeks and identified hypertensive outcomes through hospitalization diagnoses; it cannot establish that donation caused the observed differences.

In practice

For people who become pregnant after living kidney donation, this Canadian matched cohort found a higher frequency of hospitalization with gestational hypertension, preeclampsia, or eclampsia than in matched nondonors (11.9% vs 8.3%). Small-for-gestational-age birth was also more frequent (13.8% vs 7.9%). These observational findings support discussing pregnancy-related risk with donor candidates who may become pregnant and informing prenatal care after donation, but do not establish causation. Most donor pregnancies were uncomplicated, and the study included only pregnancies reaching at least 20 weeks.

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Source

JAMA: Pregnancy Outcomes After Living Kidney Donation ↗

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