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Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Serum creatinine is a key marker of renal function in pregnancy, yet reference ranges are predominantly derived from White European populations[1]. Ethnic differences in creatinine levels are well-established in non-pregnant populations, with Black individuals typically demonstrating higher creatinine even after adjusting for age, sex, height and body mass index[2]. The impact of ethnicity on creatinine levels during pregnancy remain uncharacterised. Using large-scale electronic health record data from a diverse urban population, we sought to explore whether there are ethnic differences in serum creatinine levels during pregnancy.
Retrospective cohort study including all pregnancies with available creatinine measurements across two maternity sites within King’s College Hospital NHS Foundation Trust 2016-23 (Ethical approval London South-East Research Ethics Committee, KERRI project 20241210B). Data were extracted via the CogStack informatics platform, which integrates structured and unstructured clinical data across maternity, pathology, and inpatient systems. Ethnicity was self-reported at booking and categorised using Office for National Statistics collapsed groups (White, Black, Asian, Mixed, Other). Serial creatinine values were linked to gestational age to model trimester-specific and longitudinal trends. Between-group differences were assessed using Kruskal–Wallis tests, with Bonferroni correction for multiple comparisons.
We identified 41,918 creatinine measurements taken during 16,502 pregnancies in 15,313 women with recorded ethnicities. The cohort was ethnically diverse (51.5% White, n=7879; 24.0% Black, n=3673; 7.7% Asian, n=1177; 1.7% Mixed, n=267; and 15.1% Other, n=2317).
The number of recorded creatinine measurements increased as gestation progressed, peaking at week 38 (Figure 1a). The percentage distribution of blood tests by ethnicity in our cohort remained constant throughout pregnancy (Figure 1a).
Significant ethnic differences in creatinine were observed throughout pregnancy (Table 1, p<0.0001). In the first trimester (0-12 weeks), Black women had the highest median creatinine (55μmol/L) and Asian women the lowest (50μmol/L). During mid-pregnancy/second trimester (12-28 weeks), Black women maintained higher levels (50μmol/L) compared to White (48μmol/L, p<0.0001) and Asian women (46μmol/L, p<0.0001). In the third trimester (28-40 weeks), differences persisted with Black women averaging 54μmol/L, White 52μmol/L, Asian 49μmol/L (p<0.0001). All groups showed preserved physiological adaptation with a mid-pregnancy decline and late-pregnancy rise in creatinine values (Figure 1b).
This multi-ethnic cohort demonstrates substantial ethnic variation in mean pregnancy creatinine levels, with Black women exhibiting concentrations approximately 2-5 µmol/L higher compared to other ethnic groups and Asian women lowest. These findings support the need for ethnicity-specific reference ranges in pregnancy. Clinicians should consider ethnicity when interpreting creatinine results, and guidelines may require revision to incorporate ethnicity-adjusted thresholds for equitable care.
References
[1] Wiles K et al. Serum creatinine in pregnancy: a systematic review. Kidney Int Rep 2019;4: 408-19.
[2] Marino-Ramirez et al. Effects of genetic ancestry and socioeconomic deprivation on ethnic differences in serum creatinine. Gene. 2022 Jun 27;837:146709. doi: 10.1016/j.gene.2022.146709
