Long-Term Outcomes of Systemic Lupus Erythematous Patients after Pregnancy: A Nationwide Population-Based Cohort Study.

Ting-Fang Chiu,Chi-Yuan Li,Ya-Wen Chuang,Cheng-Li Lin,Tung-Min Yu,Wen-Chao Ho,Mu-Chi Chung,Chi-Jung Chung,Shang-Jyh Hwang

doi:10.1371/journal.pone.0167946

Abstract

BackgroundData 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.MethodsWe 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.ResultsSLE 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.ConclusionsOur 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.

Highlights

Systemic lupus erythematosus (SLE) is a prototypical autoimmune disease that involves multiple organs, the kidneys; systemic lupus erythematosus (SLE) mostly affects female patients at child-bearing age [1]
SLE pregnant patients exhibited significantly increased risk of end-stage renal disease (ESRD) after adjusting for other important confounders, including immunosuppressant and parity (HR = 3.19, 95% confidence interval (CI): 1.35–7.52 for pregnant non-SLE; and hazard ratios (HRs) = 2.77, 95% CI: 1.24–6.15 for nonpregnant nonSLE patients)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Summary

Introduction

Systemic lupus erythematosus (SLE) is a prototypical autoimmune disease that involves multiple organs, the kidneys; SLE mostly affects female patients at child-bearing age [1]. A growing body of evidence indicated that pregnant SLE women are at a high risk of developing maternal and fetal complications [2]. Many perinatal complications frequently develop in childbearing SLE patients, such as disease flare-up, a new onset of lupus nephritis (LN), and preeclampsia, which are associated with a higher possibility of undesired fetal outcomes, such as demise or intrauterine growth restriction. Studies verify that the flare-up rate in LN was as high as 25.6% (17.4%–33.8%) and increased the risk of maternal and neonatal morbidity [4]. Some hypertension-related diseases, such as pre-eclampsia or eclampsia, resulted in an incidence rate ranging from 11.0% to 35.0% in pregnant SLE women, which was approximately six-fold higher than that in the general population [1, 5, 6]. 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

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