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

PLoS One. 2016 Dec 19;11(12):e0167946. doi: 10.1371/journal.pone.0167946. eCollection 2016.

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.

MeSH terms

  • Adult
  • Female
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic / epidemiology*
  • Kidney Failure, Chronic / mortality
  • Lupus Erythematosus, Systemic / complications*
  • Middle Aged
  • Pregnancy
  • Pregnancy Complications / epidemiology*
  • Pregnancy Complications / mortality
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Taiwan / epidemiology
  • Young Adult

Grants and funding

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW104-TDU-B-212-113002), China Medical University Hospital, Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM104010092), NRPB (The National Radiological Protection Board) Stroke Clinical Trial Consortium (MOST 103-2325-B-039 -006), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.