title: Long-Term Outcomes of Systemic Lupus Erythematous Patients after Pregnancy: A Nationwide Population-Based Cohort Study.
abstract: BACKGROUND
  Data on long-term maternal outcomes in patients with systemic lupus erythematosus (SLE) are lacking. The study aimed to explore the relationships among SLE, pregnancy, outcomes of end-stage renal disease (ESRD), and overall mortality.
  
  
  METHODS
  We established a retrospective cohort study consisting of four cohorts: pregnant (case cohort) and nonpregnant SLE patients, as well as pregnant and nonpregnant non-SLE patients. One case cohort and three comparison cohorts were matched by age at first pregnancy and index date of pregnancy by using the Taiwan National Health Insurance Research Dataset. All study subjects were selected based on the index date to the occurrence of ESRD or overall death. Cox proportional hazard regression models and Kaplan-Meier curves were used in the analysis.
  
  
  RESULTS
  SLE pregnant patients exhibited significantly increased risk of ESRD after adjusting for other important confounders, including immunosuppressant and parity (HR = 3.19, 95% CI: 1.35-7.52 for pregnant non-SLE; and HR = 2.77, 95% CI: 1.24-6.15 for nonpregnant non-SLE patients). No significant differences in ESRD incidence were observed in pregnant and nonpregnant SLE patients. Pregnant SLE patients exhibited better clinical condition at the baseline and a significantly lower risk of overall mortality than nonpregnant SLE patients.
  
  
  CONCLUSIONS
  Our data support current recommendations for SLE patients to avoid pregnancy until disease activity is quiescent. Multicenter recruitment and clinical information can be used to further examine the association of SLE and ESRD (or mortality) after pregnancy.
authors.affiliation: Department of Pediatrics, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.
authors.forename: Ting-Fang
authors.initials: TF
authors.lastname: Chiu
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Chuang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.|Department of Medicine, College of Medicine, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Tung-Min
authors.initials: TM
authors.lastname: Yu
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Mu-Chi
authors.initials: MC
authors.lastname: Chung
authors.affiliation: Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Li
authors.affiliation: Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Chung
authors.affiliation: Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Wen-Chao
authors.initials: WC
authors.lastname: Ho
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000401:mortality; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult