Somewhere between the decision to give a kidney and the hope of building a family lies a question many donors quietly carry: whether the gift will cost them something in pregnancy. A large Canadian comparison now offers an honest, measured answer. Women who donated a kidney were somewhat more likely to face hypertensive complications and to bear smaller babies than similar women who did not, yet the great majority of their pregnancies still passed without these troubles. The findings do not forbid donation or a future birth; they ask that the possibility be spoken plainly during evaluation, so
Future Pregnancy Doesn't Rule Out Kidney Donation, But Donors Need Hypertension Counseling
Donor pregnancies showed higher hospitalization for hypertensive disorders (11.9% vs 8.3%) and more small-for-gestational-age births (13.8% vs 7.9%) than matched nondonor pregnancies.
More than 88% of donor pregnancies were unaffected
Mark
So what's the headline for someone thinking of donating?
Mimi
That wanting a pregnancy later doesn't disqualify her. Over 88% of donor pregnancies had no hypertensive disorder.
Mark
But the risk was higher.
Mimi
Yes, 11.9% versus 8.3% for hospitalization with gestational hypertension, preeclampsia, or eclampsia.
Luke
Worth noting that's hospitalization for those conditions, so it's a specific measure, not every case of high blood pressure in pregnancy.
Mark
And the small-for-gestational-age finding?
Mimi
13.8% versus 7.9%. Garg called it secondary and said it could be chance or biology.
Luke
Which means nobody knows yet. It's a signal, not an explanation.
Mark
Does age change things?
Mimi
Among mothers 35 and older the risk ratio was about 1.99. For younger mothers it was 1.41.
Luke
And that younger interval, 0.93 to 2.15, includes no difference. The subgroup pattern is suggestive, not proven.
Mark
Who might this not describe?
Mimi
Most donors in the study were White and in publicly funded systems. Donors of African ancestry, including those with APOL1 high-risk genotypes, still need study.
O Pulso
- Donor pregnancies showed a measurable rise in hypertensive complications, climbing from 8.3% to 11.9% against matched nondonors.
- Small-for-gestational-age births nearly doubled in the donor group, prompting researchers to question whether chance or biology is at work.
- Older mothers, aged 35 and above, face the sharpest contrast, with complication rates nearly doubling after donation.
- Transplant teams are moving to bring pregnancy plans into donor evaluations, guided by the 2017 KDIGO recommendation.
- Yet most donor pregnancies remain unaffected, and the results are landing as reassurance paired with careful watchfulness.
Somewhere between the decision to give a kidney and the hope of building a family lies a question many donors quietly carry: whether the gift will cost them something in pregnancy. A large Canadian comparison now offers an honest, measured answer. Women who donated a kidney were somewhat more likely to face hypertensive complications and to bear smaller babies than similar women who did not, yet the great majority of their pregnancies still passed without these troubles. The findings do not forbid donation or a future birth; they ask that the possibility be spoken plainly during evaluation, so that a donor can weigh her own path with clear eyes.
A woman considering giving a kidney to someone in need may also be asking whether she can still carry a child afterward. New data from three Canadian provinces, presented at Kidney Week 2026 and published in JAMA, give transplant teams firmer ground for that conversation. The answer is yes, with some caveats about blood pressure.
Researchers compared 385 pregnancies in women who had donated a kidney with 1,540 pregnancies in similar women who had not. Hospitalization for gestational hypertension, preeclampsia, or eclampsia occurred in 11.9% of donor pregnancies and 8.3% of the others. More than 88% of donor pregnancies were not affected. Small-for-gestational-age births were also more frequent among donors, at 13.8% versus 7.9%, though the lead investigator, Amit Garg, called this a secondary finding that might be chance or biology.
Garg was clear that interest in a future pregnancy should not disqualify anyone from donating. He emphasized healthy lifestyles after donation and careful monitoring, since obesity also raises preeclampsia risk. Counseling, he argued, should include the possible effect of donation on pregnancy, and the 2017 KDIGO guideline already points in that direction. Risk looked highest among mothers 35 and older, though the sample is limited, mostly White, and drawn from publicly funded systems. Further study among donors of African ancestry is still needed.
A woman weighing whether to give a kidney to someone who needs one may also be wondering whether she can still have a child afterward. New data from Canada now give transplant teams firmer numbers to offer her, and the answer is yes, with some caveats about blood pressure.
The findings were presented at the American Society of Nephrology's Kidney Week 2026 by Amit X. Garg, MD, PhD, and published at the same time in JAMA. The study drew on three Canadian provinces and compared 385 pregnancies in women who had donated a kidney with 1,540 pregnancies in matched women who had not donated and were of similar baseline health.
The main result concerned hospitalization for gestational hypertension, preeclampsia, or eclampsia. That happened in 11.9% of donor pregnancies and 8.3% of nondonor pregnancies, a risk ratio of 1.51 (95% CI, 1.10-2.08). Put the other way, more than 88% of donor pregnancies were not affected by these conditions.
There was a second signal. Small-for-gestational-age births were more common among donors, at 13.8% versus 7.9% (RR, 1.86; 95% CI, 1.37-2.52). Garg described this as a secondary finding that could reflect chance or biology. The study did not settle which.
Other outcomes did not differ between the groups. Severe maternal morbidity, cesarean delivery, postpartum hemorrhage, gestational diabetes, preterm birth or low birth weight, and admission to neonatal intensive care were all similar.
Garg, a professor of medicine, epidemiology and biostatistics at Western University, a nephrologist at London Health Sciences Centre, and the study's corresponding author, was direct in an interview with HCPLive. Interest in a future pregnancy, he said, does not preclude someone from being a donor. He also stressed healthy lifestyle behaviors after donation, noting that obesity is associated with a higher risk of preeclampsia, along with appropriate monitoring for these complications. Because living kidney donation is performed worldwide, he said, transplant centers should be confident donors will be able to get good maternal care if they become pregnant.
On counseling, the 2017 KDIGO guideline on living kidney donors already recommends telling candidates about a potentially increased risk of gestational hypertension or preeclampsia. Garg said the new results support that advice, including asking candidates during evaluation about their plans for pregnancy. In his words, counseling should cover the possible effect of donation on future pregnancy, including that higher risk.
Age may sharpen the conversation. Among pregnancies in mothers 35 or older, the primary outcome occurred in 14.3% of donors versus 7.6% of nondonors (RR, 1.99; 95% CI, 1.18-3.33). Among younger mothers the risk ratio was 1.41, and its confidence interval (0.93-2.15) was wide enough to include no difference.
The investigators noted limits. Most Canadian donors are White and receive care in publicly funded health systems, which may restrict how far the results apply elsewhere. They called for more study among donors of African ancestry, including those with apolipoprotein L1 high-risk genotypes. Garg reported no relevant disclosures.
Citações Notáveis
If someone is interested in having a pregnancy after donation, that doesn't preclude them from being a donor.— Amit X. Garg, MD, PhD, Western University
Quer a matéria completa?
Leia o original em HCPLive ↗
Education