André Blais

Eric Guntermann

Vincent Arel-Bundock

Ruth Dassonneville

Jean-François Laslier

Gabrielle Péloquin-Skulski

André Blais

Arel-Bundock Blais

WORKING PAPER N° 2020 -57 Party Preference Representation

Keywords: party preference representation, party like/dislike, elections, cabinet, legislature 1 party preference representation, party like/dislike, elections, cabinet, legislature

Political parties are key actors in electoral democracies: they organize the legislature, form governments, and citizens choose their representatives by voting for them. How citizens evaluate political parties and how well the parties that citizens evaluate positively perform thus provide useful tools to estimate the quality of representation from the individual's perspective. We propose a measure that can be used to assess party preference representation at both the individual and aggregate levels, both in government and in parliament. We calculate the measure for over 160,000 survey respondents following 111 legislative elections held in 38 countries. We find little evidence that the party preferences of different socio-economic groups are systematically over or underrepresented. However, we show that citizens on the right tend to have higher representation scores than their left-wing counterparts. We also find that whereas proportional systems do not produce higher levels of representation on average, they reduce variance in representation across citizens.

Elections offer citizens the opportunity to express their views about the issues of the day, the parties and the candidates. The hope is that the candidates and parties, in order to maximize their chances of being elected, will take issue positions that reflect the public's preferences, and that as a consequence there will be strong correspondence between public opinion and the decisions made by legislators and government [START_REF] Downs | New York: Harper and Brothers. An Economic Theory of Democracy[END_REF]. This is what electoral democracy is supposed to achieve [START_REF] Powell | Elections as Instruments of Democracy: Majoritarian and Proportional Visions[END_REF].

Whether that goal is achieved or not is therefore a key question which, for good reasons, has been the object of much work in political science. Many empirical studies have examined the correspondence between the public's policy preferences and the actual policies enacted by governments (Erickson, Mackuen and Stimson 2002;Hobolt andKlemmensen 2005, 2008;Soroka and Wlezien 2010). Other studies have ascertained the degree of congruence in the ideological orientations of the mass public on the one hand and legislators and governments on the other (e.g. [START_REF] Golder | Electoral Rules and Citizen-Elite Ideological Congruence[END_REF][START_REF] Golder | Re-evaluating the Relationship between Electoral Rules and Ideological Congruence[END_REF][START_REF] Golder | Ideological Congruence and Electoral Institutions[END_REF]Huber and Powell 1994). All these studies focus on substantive representation, but the literature is not limited to work that considers the interests and preferences of citizens. A second and influential perspective has been to examine the issue of descriptive representation [START_REF] Pitkin | The Concept of Representation[END_REF][START_REF] Mansbridge | Rethinking representation[END_REF] where the concern is whether the socio-demographic characteristics of legislators mirror those of the electorate. Work in the field of gender and politics, for instance, has shown that such descriptive representation not only has an important symbolic effect [START_REF] Wolbrecht | Role models revisited: Youth, novelty, and the impact of female candidates[END_REF] but can also facilitate the substantive representation of group interests [START_REF] Clayton | Quota shocks: Electoral gender quotas and government spending priorities worldwide[END_REF].

In this paper, we study substantive representation, that is, we ascertain the extent to which citizens' preferences are well reflected in the outcome of the election. In doing so, we move away from a focus on policy preferences and ideology and instead assess the correspondence between citizens' party ratings and these parties' presence in the legislature and government. We argue that focusing on parties and their electoral success is meaningful because legislative elections are first and foremost about how many seats the various parties will have in the legislature and which parties will form government. Voters vote mostly for parties, and they are more satisfied when the party they like best is in government [START_REF] Anderson | Losers' Consent : Elections and Democratic Legitimacy[END_REF]. We also think that a focus on party preferences is appropriate for a comparative analysis of representation, as we do not have to make any assumptions about similarities in the dimensionality of politics or the salience of policy issues across countries.

We construct measures of party preference representation in 111 legislative elections and find little evidence that our measures vary systematically with age, gender, education, income, or between urban and rural areas. However, we find that right-wing voters are better represented than left-wing voters. Interestingly, proportional representation systems do not seem to produce higher levels of overall representation, but they do lead to less variance in representation across citizens.

The rest of this article proceeds in four steps. First, we motivate our focus on party preferences to gauge representation. Second, we operationalize the concept of "party preference representation". Third, we describe cross-national survey and election results data which can be used to estimate an individual's degree of representation. Finally, we study how the representation of party preferences varies across socio-demographic and ideological groups and types of electoral systems. We end with a discussion of the implications of our findings.

Why study party preference representation?

To capture the quality of representation, scholars generally measure the congruence between citizens' policy preferences, or their ideological orientations, and those of decision-makers. Such work, however, has to make tough decisions about which issues to take into account or which ideological dimensions to consider for measuring congruence. As a result, most previous studies either focus on the correspondence between public opinion and the government's or parliament's position along the left-right dimension [START_REF] Golder | Re-evaluating the Relationship between Electoral Rules and Ideological Congruence[END_REF][START_REF] Golder | Ideological Congruence and Electoral Institutions[END_REF], or they investigate congruence in a specific policy domain, such as welfare spending [START_REF] Kang | Representation and Policy Responsiveness: The Median Voter, Election rules, and Redistributive Welfare Spending[END_REF][START_REF] Hooghe | Public Opinion, Turnout and Social Policy: A Comparative Analysis of Policy Congruence in European Liberal Democracies[END_REF]. When studying these questions comparatively, such an approach has two kinds of limitations. First, in many countries, the political space is characterized by more than one dimension [START_REF] Bakker | Measuring Party Positions in Europe: The Chapel Hill Expert Survey Trend File, 1999-2010[END_REF] and voters care about more than a single left-right dimension [START_REF] Stecker | Multidimensional Government-Citizen Congruence and Satisfaction with Democracy[END_REF]. Second, the meaning of left and right differs between countries [START_REF] Piurko | Basic Personal Values and the Meaning of Left-Right Political Orientations in 20 Countries[END_REF]) and over time [START_REF] De Vries | The Dynamics of Voters' Left/Right Identification: The Role of Economic and Cultural Attitudes[END_REF].

Focusing on party preference representation, in contrast, allows for more flexibilityas voters tend to vote for the parties that they believe best represent their views about the issues of the day, whatever these issues are. Furthermore, voters do not vote only on the basis of their policy preferences, they take into account many other considerations, such as the perceived competence or honesty of the various candidates and parties. At the end of the day, based on all of these considerations, they form overall evaluations of the parties and vote on the basis of these evaluations. 2 Our assumption, therefore, is that citizens want the parties they like (dislike) to perform well (poorly).

Based on this reasoning, we argue that an individual will feel well (poorly) represented when the parties she likes (dislikes) perform well, that is, when their preferred parties win many seats in the legislature and cabinet. Assuming that is indeed the case, the electoral performance of the parties that a citizen likes is an appropriate indicator of how well her views are represented. More precisely, when the legislature and the government are composed of parties that a voter likes, her views are well represented. On the contrary, when the legislature and government are composed of parties that she dislikes, she is poorly represented. To capture this idea, in the next section, we introduce a measure of citizens' degree of party preference representation associated with the outcome of an election. This measure combines information on election results with data on citizens' evaluations of political parties.

Our approach is in line with that of [START_REF] Blais | Linking party preferences and the composition of government: A new standard for evaluating the performance of electoral democracy[END_REF], who use party ratings as the reference point for assessing the quality of representation in government at the aggregate level, and with that of Guntermann, [START_REF] Guntermann | Are Inequalities in Representation Lower under Compulsory Voting?[END_REF] who ascertain the degree of representation of poor and rich citizens based on how these two groups like parties in government relative to parties in opposition. What is novel is that we propose a measure that can be used to assess representation in both parliament and government, at both the individual and aggregate level.

Groups, institutions, and representation

In addition to introducing a measure of party preference representation, we examine descriptively whether some groups are better represented (in terms of party preferences) and whether some institutions foster better representation. In doing so, we focus on three dimensions: socio-demographic characteristics, ideology, and electoral systems.

Whether some groups such as women, the poor, youth, the less educated, or those living in rural areas, are less well represented than others is a perennial issue that is debated by scholars, the media and the larger public. The debate here is three-fold. First, there is the issue of descriptive representation, dealing with the question whether specific groups are over or underrepresented in parliament or cabinet. Second, there is the issue of substantive representation, that is concerned with whether the interests of some groups are better reflected in the composition of parliament or cabinet or its decisions. Third, there is the question how much substantive representation depends on descriptive representation. In this study we are concerned with the substantive representation of groups that prior research has shown to be disadvantaged in terms of descriptive representation, such as the young, women, and the poor.

At the institutional level, previous work primarily focuses on the contrast between proportional and majoritarian systems. As [START_REF] Powell | Elections as Instruments of Democracy: Majoritarian and Proportional Visions[END_REF] has elegantly argued, these two electoral systems correspond to two visions of democracy. The majoritarian vision insists on voters' ability to pass reward/punish judgments about the performance of the governing party as the main mechanism through which the political elite is induced to pay attention to public opinion. In contrast, the proportional vision puts the emphasis on the importance of bringing all segments of the population into the policy-making arena. The proportional vision stresses the need to find compromises that will satisfy as many people as possible. There is a huge literature arguing that proportional representation fosters better representation [START_REF] Lijphart | Patterns of Democracy: Government Forms and Performance in Thirty-Six Contries[END_REF][START_REF] Powell | Elections as Instruments of Democracy: Majoritarian and Proportional Visions[END_REF], that the two systems perform equally [START_REF] Blais | Does Proportional Representation Foster Closer Congruence Between Citizens and Policymakers?[END_REF][START_REF] Golder | Re-evaluating the Relationship between Electoral Rules and Ideological Congruence[END_REF] or that they perform best on different measures of representation [START_REF] Blais | Linking party preferences and the composition of government: A new standard for evaluating the performance of electoral democracy[END_REF].

Finally, as we are dealing with party preference representation, it makes sense to wonder whether some parties and their supporters are better represented than others. Parties can be distinguished on the basis of many different criteria, but the most salient and common cleavage is that between right-wing and leftist parties [START_REF] Dalton | Political and Democratic Linkage: How Parties Organize Democracy[END_REF]. A point of discussion in the literature on the link between ideology and representation is whether right-wing supporters are better represented than those on the left, and also, as suggested by [START_REF] Iversen | Electoral institutions and the politics of coalitions: Why some democracies redistribute more than others[END_REF], whether the right is better represented under a majoritarian system and the left under proportional representation.

Measuring party preference representation

Our operationalization of party preference representation considers two pieces of information: election outcomes and citizens' party preferences. First, the outcome of the election can be captured through information on the seat shares that different parties obtain in the legislature or by their presence in government. Second, individuals have sets of party preferences, with varying intensities. 3 By combining these two pieces of information, we wish to obtain an estimate of how well an individual's preferences are represented. The basic idea is that an individual's degree of representation is highest (lowest) when the parties she likes the most perform well (poorly), that is, they get many (few) seats in the legislature and cabinet.

Our approach is similar to that adopted by Hajnal (2009) in his analysis of the degree of representation of African Americans in U.S. elections. As an indicator of representation Hajnal takes the proportion of voters in a given socio-demographic group that is on the winning side in the election. The underlying logic is simple: "how often a group wins or loses seems to provide a telling account of democratic outcomes." (Hajnal 2009, 41). We focus on the outcomes of elections as well. To be clear, our approach differs from that of Hajnal. We consider the performance of the party one supports rather than that of the individual candidate one voted for, and we have measures of party preference rather than vote to take into account strategic considerations. Still, the basic premise remains the same: a person is better represented when the candidate (party) she votes for (prefers) wins (get many seats in parliament or government).

To construct our measure, we link the individual's ratings of the parties and the results of the election, with a focus on legislative elections. These elections decide how many seats each party has in the legislature and, indirectly, how many seats each party has in government. Hence, the more (fewer) seats the parties that the voter likes (dislikes) have, the greater the representation she derives from the outcome of the election. Like recent studies [START_REF] Blais | Linking party preferences and the composition of government: A new standard for evaluating the performance of electoral democracy[END_REF][START_REF] Guntermann | Are Inequalities in Representation Lower under Compulsory Voting?[END_REF], we consider parties' cabinet seat shares. We also consider their seat shares in the legislature, which can also be a means to influence policy [START_REF] Tsebelis | Veto players: How Political Institutions Work[END_REF].

We combine individuals' like/dislike ratings of the parties with the parties' electoral performance to construct our measure of party preference representation. Like [START_REF] Abramson | Sophisticated' Voting in the 1988 Presidential Primaries[END_REF], we normalize ratings at the individual level. For each respondent, the most preferred party (parties) has a score of one and the least preferred party (parties) gets a score of zero. 4 In doing so, we account for the possibility that some citizens rate all parties more positively (or negatively) than others. 5 The overall representation that an individual voter derives from the outcome equals the degree of representation associated with the performance of the various parties. Let 𝑃 represent the set of parties 𝑝 for which respondent 𝑖 can vote, and 𝐿 𝑖𝑝 the rating of 𝑖 for party 𝑝. If 𝑆 𝑝 represents the share of seats won by 𝑝,6 then 𝑖's degree of representation is:

𝑅 𝑖 = ∑ 𝑝∈𝑃 𝐿 𝑖𝑝 -𝐿 𝑖 𝐿 𝑖 -𝐿 𝑖 ⋅ 𝑆 𝑝 ,
where 𝐿 𝑖 is a respondent's favorite party's score (𝑚𝑎𝑥 𝑝∈𝑃 (𝐿 𝑖𝑝 )), and 𝐿 𝑖 is the respondent's least favorite party's score (𝑚𝑖𝑛 𝑝∈𝑃 (𝐿 𝑖𝑝 )). We produce an analogous measure of representation using the share of cabinet positions instead of the share of seats in parliament. We thus have two measures of representation: legislative representation and cabinet (government) representation.

To clarify the measure, consider a hypothetical case where there are three parties running in a given election, and where an individual expresses the following ratings: 2, 4, 6. Using the above formula, we calculate the rescaled scores as: 0, 0.5, and 1. If the third party fails to win any seats in the legislature and the first two parties share seats evenly, then that individual's (legislative) party preference representation is equal to 0.25. This is the measure that we use in our main analyses. We also perform robustness checks with an alternative unstandardized measure, applying the following formula:

𝑅 𝑖 = ∑ 𝑝∈𝑃 𝐿 𝑖𝑝 10 ⋅ 𝑆 𝑝 ,
Party ratings are again normalized from 0 to 1. However, this measure does not fix the highest rated party rating at 1 or the lowest rated party at 0. The maximum representation score of 1 is obtained when the individual gives a score of 10 to all the parties that obtain seats and the minimum score of 0 when the individual gives a score of 0 to all the parties that win seats.

Data

To study individual party preference representation empirically, we use the Integrated Module Dataset (IMD) from the Comparative Study of Electoral System (CSES) project. 7 Research teams participating in the CSES collaborative research program agree to field a common set of questions in their post-election surveys. The combined dataset of the first four thematic modules of the CSES projectreferred to as IMDincludes data from over 50 countries and spans the period from 1996 to 2016. While questions vary somewhat from one module to the next, party like/dislike ratings were included in all four CSES-modules. The exact question wording is the following: "I'd like to know what you think about each of our parties. After I read the name of a political party, please rate it on a scale from 0 to 10, where 0 means you strongly dislike that party and 10 means that you strongly like that party. If I come to a party you haven't heard of or you feel you do not know enough, just say so." National election teams are invited to ask respondents to rate the six parties that received the most votes, with the possibility, from module 2 onwards, to include up to three additional parties. 8 These like/dislike ratings provide information about respondents' set of preferences among the various parties. 9

Taking the IMD dataset, we consider all (lower house) legislative elections in systems in which these influence the composition of government as well as of the legislature. In other words, we focus on parliamentary or premier-presidential systems and therefore exclude all elections held in presidential or president-parliamentary systems [START_REF] Bormann | Democratic Electoral Systems Around the World, 1946-2011[END_REF][START_REF] Shugart | Semi-Presidential Systems: Dual Executive And Mixed Authority Patterns[END_REF].

We also exclude all elections with a Polity score lower than 6. Data on the distribution of seats in parliament and government come mainly from the CSES. However, for elections in the first module of the CSES and elections where the full seat distribution is not provided, they were complemented with data from Parlgov and the European Journal of Political Research Political Data Yearbook.

It should be noted that we only include the parties for which respondents provided a rating.

When no information about a respondent's rating are available for a given party, that party's seats are excluded from the calculation of the seat share. Individuals who did not provide ratings for at least two parties (for whom we do not have relative preferences) or who gave the same score to every party (who are construed to be indifferent) are excluded. Excluding parties with missing values could artificially increase the representation of 'included' parties, assuming that the parties with missing values are unlikely to be preferred. We note, however, that only six parties not included in the 111 elections covered by our study had seats in the legislature.

As a robustness check, we have imputed missing party ratings five times using the "mice" software by [START_REF] Van Buuren | mice: Multivariate imputation by chained equations in R[END_REF]. With this approach, the party rating of an individual for a given party is imputed based on the party ratings that this same individual has given to the other parties. The results using imputed ratings are reported in Appendix E and not substantively different from those shown in the text.

All in all, our dataset comprises 160,000 individuals and 111 elections held in 38 countries. To 8 There is variation in the timing of these post-election studies, though in general the surveys were fielded immediately following the election. For the observations for which the IMD dataset has information on the timing of the interview, the average number of days between the election and the interview was 50 days, and half of the interviews were done within 23 days from the election. We tested whether representation scores are affected by the timing of the interview. We have thus performed additional estimations which included the number of days between the election and the interview. That variable is not statistically significant, and our results remain unchanged when including this variable. 9 Our approach is in line with the common approach in the strategic voting literature whereby "each respondent's preferences…is determined by comparing the feeling thermometer scores given to each party." (Abramson et al. 2018, 36-37).

facilitate the interpretation of our results, every variable is rescaled to the [0,1] interval. Histograms for all variables are shown in Appendix B.

The mean representation score derived from the composition of the legislature is .55 and the mean score associated with the composition of the government is .60. In both cases, mean representation is above the midpoint, which is good from a normative point of view and reflects the fact that parties that have higher ratings are over-represented in both the legislature and the executive. Since all the surveys took place after the elections one cannot rule out, however, the possibility that this finding is an artifact of winning the election, that is, that electoral success causes higher ratings rather than higher ratings causing electoral success. The standard deviation of representation derived from the composition of the cabinet is higher (.33) than that associated with the composition of the legislature (.17) since many parties are represented in the latter but not in the former.

Figure 1 presents the distribution of the two representation measures (cabinet and legislature). We can see that the degree of representation derived from the legislative outcome (the right-hand graph) is bell-shaped. Things are different with respect to cabinet derived representation (graph to the left). Indeed, 9% of the respondents have a score of 0, which means that the parties that the respondent dislikes the most control the government, while 17% have a score of 1, which indicates that the parties that the respondent likes the most hold all cabinet seats. Figure 1 conveys the fact that more people are above the mid-point than under, which stems from the overrepresentation of more popular parties in the legislature and (even more) in cabinet.

Figure 1: Distribution of party preference representation

It is important to stress the similarities and differences between our approach and previous ones, specifically those based on policy and ideological congruence. The basic similarity is a correspondence between what people want and what they get. In all cases, citizens' preferences are the reference point. The approaches differ with respect to the type of preference that is considered: policy, ideological, or partisan. Each approach has a different focus, and thus deals with a different outcome: policy decisions, the ideological orientations of legislators or governments, or the partisan composition of legislatures and governments.

Our approach is close to the ideological congruence perspective in the sense that in both cases citizens' preferences are linked to the outcome of an election. The only difference is that in one case ideology serves as the criterion while it is party preferences in our approach. The case for ideology is that it is a good proxy for the overall orientation of public policies. The problem is that ideological congruence studies are often forced to rely on one specific ideological dimension (left-right) that is less relevant for some people and in some countries. Furthermore, citizens have other types of preferences that are not taken into account in studies of ideological congruence. The case for our approach is that a legislative election is first and foremost about which parties will govern and, as a consequence, party preferences constitute the most meaningful focus when we are considering the outcome of an election.

What about policy congruence? That approach has one great advantage. It compares what people want governments to do with what governments actually do. The outcome is a concrete decision.

The major limitation is that it is impossible to analyze all public policies and to distinguish those that are most and least important. Our approach has the advantage of relying on a more global criterion, party preferences, which encompass judgments about whatever policies each individual deems salient, as well as many other considerations, and the disadvantage of being confined to the electoral outcome. With our approach we are ascertaining whether citizens' preferences are well represented on election night, so to speak, and not whether they are reflected in the decisions that are made in the following months and years.

Party preference representation across socio-demographic groups

Having developed and operationalized a measure of individuals' party preference representation, we can evaluate whether and to what extent that measure is associated with citizens' sociodemographic characteristics. We consider five socio-demographic characteristics: age, gender, education, income, and the rural/urban cleavage. These socio-demographic variables are consistently included in the CSES dataset and they are measured in a standardized way across countries. In addition, each of these variables has previously been found to be politically relevant, and to correlate to voters' choices (see, e.g., the section on sociological approaches in Arzheimer et al. 's [2017] handbook of electoral behavior).

In recent years, a number of studies have considered the extent to which different groups in the population have different levels of influence on government policy (e.g. Bartels 2016; [START_REF] Gilens | Inequality and Democratic Responsiveness[END_REF][START_REF] Gilens | Affluence and Influence: Economic Inequality and Political Power in America[END_REF]. Such studies have largely focused on the relative influence of different income groups. The approach is a policy congruence one. Gilens, in particular, shows that public policies in the United States better reflect the preferences of the rich than those of the poor. We note, however, that the bias is limited: for instance, the probability that a policy is adopted when 90% of the rich are in favour of that policy is only 49%, compared to 42% when 90% of the poor support it [START_REF] Gilens | Inequality and Democratic Responsiveness[END_REF], Table 1, page 785).10

Our focus is different. Our concern is whether the electoral outcome better reflects the preferences of the rich. It is quite possible that after an election, the rich, being better organized, are more capable of shaping the decisions reached by governments [START_REF] Leighley | Representation in an Era of Political Economic Inequality: How and When Citizen Engagement Matters[END_REF].

We assess the correspondence between preferences and electoral outcomes.

The question that we ask is whether the parties that are preferred by one group, such as the rich, perform systematically better in elections than the parties that are preferred by another group, such as the poor. We can see two reasons for such unequal representation. The first is that one group has a higher turnout, and as a consequence the parties it likes performs better. The second is that one group has more money and donates more money to its preferred party, and as a consequence the party it supports spends more and performs better.

Both arguments are not very convincing. It is true that turnout is higher among the rich than among the poor [START_REF] Leighley | Who Votes Now?[END_REF], though it should be pointed out that turnout is more strongly correlated with age and education than with income [START_REF] Nevitte | Socioeconomic Status and Nonvoting: A Cross-National Comparative Analysis[END_REF]. Such reasoning, however, assumes that electoral outcomes would be different if turnout was very high.

The studies that have examined that assumption have produced conflicting results. Some studies have shown support for the assumption [START_REF] Martinez | The Effects of Turnout on Partisan Outcomes in U.S. Presidential Elections 1960-2000[END_REF][START_REF] Kohler | Estimating the potential outcome of nonvoter on outcomes of parliamentary elections in proportional systems with an application to German national elections from 1949 to 2009[END_REF]) but many others find no or tiny effects [START_REF] Highton | The political implications of higher turnout[END_REF][START_REF] Burnhagen | The partisan effects of low turnout: Analyzing vote abstention as a missing data problem[END_REF][START_REF] Van Der Eijk | Political effects of low turnout in national and European elections[END_REF][START_REF] Rubenson | Does low turnout matter ? Evidence from the 2000 Canadian Federal Election[END_REF]).

As for the role of money in elections, there is a rich literature which shows that campaign spending has an impact on the vote in American elections, though there may be diminishing returns over a certain level and spending by challengers may matter more than spending by incumbents. The question, however, is whether this systematically advantages one party over another. This is far from clear. [START_REF] Abramowitz | Campaign Spending in U.S. Senate Elections[END_REF] analysis of campaign spending in U.S.

Senate elections shows 'the absence of any clear Republican advantage except among incumbents.' (page 490). Furthermore, 'this advantage has not translated into greater electoral security.' (page 490). There is even greater doubt about the role of money in Europe because of stronger regulation of campaign finance in general and political advertising in particular. Specifically, there are countries where advertising on radio and television is prohibited, others where it hardly exists, and quite a few others where broadcast time cannot be purchased (Holtz-Bacha and Kaid 2014, pages 558-559).

As a consequence, we expect the socio-demographic bias in party preference representation to remain small, overall.

To verify whether the socio-economic groups that we consider have systematically higher or lower party preference representation scores, in Table 1 we regress individuals' score with respect to the composition of the legislature on five variables: age, gender, education, income, and the urban/rural cleavage. In Table 2, we do the same with the representation scores derived from the composition of the cabinet. We focus on bivariate relationships since our objective is descriptive. The findings, however, are very similar with multivariate estimations, as can be seen in Appendix C. All models include election fixed effects.

Given the large sample size, we can precisely estimate the coefficients of interest. We therefore focus on the substantive magnitude of the effects. As can be seen from the results in Tables 1 and2, neither the legislative representation score nor the cabinet representation score meaningfully varies across socio-demographic groups. Even with a large sample, most of the coefficients are not statistically significant. The largest gap is that associated with income, but even in that case the effect is substantively small. Across all 111 elections covered by our study, the legislative representation score of the richest is a mere .026 higher than that of the poorest (a difference of 5% relative to the mean); the difference is only slightly higher (.048) for the cabinet representation score. A one standard deviation increase in income is associated with increases of 0.009 and 0.017 standard deviation respectively on the legislature and cabinet representation scores. The effects of age, gender, education and the rural/urban divide are even smaller, and mostly not statistically significant. Electoral outcomes in contemporary democracies are not systematically biased against the partisan preferences of socio-demographic groups. Even though we do not find substantial overall differences in citizens' electoral representation scores, this does not mean that there is no meaningful variation in any of the elections. It is possible, for example, that men have a higher score in some elections and a lower score in other cases, implying that these two effects would cancel out in the aggregate. To account for such election-specific patterns, we performed similar analyses for each of our five socio-demographic variables in each of the 111 elections. Given the large number of estimations, we adjust for multiple comparisons by using the Holm correction to adjust the p-value in each regression. Appendix D presents the findings for each of our five socio-demographic characteristics and for each of the 111 elections, and with respect to the outcome in both the legislature and cabinet. Of the 1072 coefficients for the socio-demographic variables with the standardized measure that are shown in Appendix D, only 150 are significant. The bottom line is that in a typical election, there is no substantial variation in overall electoral representation score across socio-economic groups.

The findings presented above are based on our main party preference representation measure. All models also exclude respondents who do not rate at least two of the parties or who give the same ratings to all of the parties. In Appendix E, we replicate the main analyses when imputing missing values for party ratings for both the standardized and unstandardized measure of party preference representation. The patterns that emerge from those additional analyses are very similar to those reported here.

Party preference representation and ideology

In a second step, we look at the role of ideology. This concerns a variable that is known to shape politics and elections in important ways [START_REF] Dalton | Political and Democratic Linkage: How Parties Organize Democracy[END_REF]. By focusing on this variable and its connection to party preference representation, we can determine whether people on the left generally derive a higher or lower degree of party preference representation than those on the right. This would occur if there is a systematic tendency for governments and legislatures to be more on one side of the ideological spectrum. Absent such a systematic bias, there should be no difference in representation score between citizens on the left and those on the right.

We also examine whether those with more extremist views derive a lower degree of preference representation. We expect differences between citizens with extreme ideologies and citizens with more moderate ideologies. The former support parties that are less popular than the latter and thus perform poorly in elections, which likely leads them to derive lower representation from electoral outcomes. Furthermore, given that electorally successful extreme parties are often excluded from coalition governments (van Spanje and van der Brug 2007), there might be an additional disadvantage for citizens with extreme preferences when focusing on government composition.

We consider individuals' self-placements on the 0 to 10 left-right scale. The ideology variable is standardized on a 0 to 1 scale (see Appendix A for a description) where 0 means far-left and 1 far-right. Extremism corresponds to the absolute distance between the individual's selfplacement and the mid-point (5) of the scale, also standardized on a 0 to 1 scale, whereby those who place themselves in the centre (5) of the scale have a score of 0 and those who are at the extremes (0 or 10) have a score of 1.

Table 3 shows the results of a series of bivariate regression models to explain party preference representation. We also performed multivariate estimations (Appendix C), which produce similar findings. The estimates suggest that citizens who are at the extremes of the left-right scale derive lower representation from electoral outcomes. This is the consequence of them being a minority group (there are many more centrists), which leads to their own partisan preferences being more likely to depart from those of their centrist counterparts and thus their preferred parties being weakly represented in the legislature and government. The association between extremism and representation is weak. All in all, the legislative representation score of those at 0 or 10 on the left-right scale is only .056 lower than that of those right in the center (5). Even more surprising is the fact that the impact of extremism is not bigger with respect to the representation score derived from government composition.

Finally, the partisan preferences of those on the right are more strongly reflected in Parliament and government. The impact with respect to the composition of the legislature is modest. An extreme right citizen's representation score is .071 higher than that of an extreme left citizen, and the impact of left-right ideology is greater than that of extremism. The effect is bigger (.199) at the cabinet level. When party preference representation is defined at the level of government, right-wing voters are clearly better represented than those on the left. One reason why those on the right exhibit a greater degree of preference representation is that there are more people on the right than on the left (the parties that are better liked overall are likely to be overrepresented in parliament and even more so in cabinet). Among all respondents in our sample, 40% have a left-right score greater than .5 while 32% have a score lower than .5. However, although we find that there are many elections where people from the right obtain greater representation, there are others where they derive lower representation. In 51 elections those on the right are significantly better off, whereas, for those on the left, this is the case in only 9 elections.

To better understand this pattern, we consider contextual variations in the association between left-right ideology and degree of electoral representation. Although people from the right have a higher representation score overall because they are more numerous, the main factor at play here is clearly the ideological orientation of the government. Put simply, when the government is on the right, right-wing voters derive a higher representation score from the outcome of the election; the opposite holds when there is a leftist government. This is shown in the left-hand graph of Figure 2. Here the unit of analysis is the election. There is a very strong correlation (+.84) between the ideology of the government (see Appendix A for a description) and the value of the coefficient associated with voters' ideology (estimated from election-specific regressions linking, in each election, voters' ideology to their party preference representation score). That is, the more right-wing (left-wing) the government, the higher the relative representation of right-wing (left-wing) voters. We should note that when the government is exactly in the centre (0.5 on the ideology scale), the predicted coefficient is exactly 0, that is, there is no gap in the degree of preference representation between those on the left and those on the right. The reason why voters on the right are more often advantaged in our sample is that there are more governments on the right than on the left. More precisely the mean government score in our sample is .55; 63% of the governments are above 0.5. And one reason why there are more right-wing governments is that there are more voters on the right than on the left. The right-hand graph of Figure 2 shows the relationship between mean voter ideology and government ideology (here again the unit of analysis is the election). The correlation (+.38) is relatively strong.

We cannot explore in this paper why there are more voters and governments on the right than on the left. We should note, however, that this was not always the case. 11 Iversen and Soskice's ( 2006) analysis of government ideology for the 1945/1998 period found about as many left-wing as right-wing governments.

Figure 2. The relationship between Mean Voter Ideology, Government Ideology, and Left-Right Gap in Legislative Representation

To evaluate the robustness of these results, in Appendix E, we perform the analyses reported in Table 3 when imputing missing values for party ratings with the standardized and unstandardized measures. The patterns are very similar, that is, the impact of extremism is weak or non-significant while that of ideology is more substantial, especially with respect to cabinet representation.

Whereas we find little systematic variation in the degree of party preference representation across socio-economic groups, we observe that voters on the right derive greater representation most of the time. They do so for the simple reason that there are more right-wing than leftist governments.

Party preference representation and electoral systems

We finally consider the electoral system. We are interested in the contrast between proportional and non-proportional systems, that we operationalize in different ways (see below). Our prediction is that the mean voter degree of representation is similar in both types of systems. This prediction is inspired by previous research [START_REF] Blais | Linking party preferences and the composition of government: A new standard for evaluating the performance of electoral democracy[END_REF][START_REF] Golder | Ideological Congruence and Electoral Institutions[END_REF] which has shown little systematic difference between proportional and disproportional systems in terms of overall congruence between citizens and policy makers. However, we expect the distribution of representation scores to be more equal in more proportional systems. The reason is that seat share (in both the legislature and the cabinet) is more concentrated in majoritarian systems where bigger parties are overrepresented in the legislature and where the cabinet is usually a single-party government. As a consequence, majoritarian systems are characterized by a greater contrast between winners and losers [START_REF] Anderson | Political Institutions and Satisfaction with Democracy: A Cross-National Analysis of Consensus and Majoritarian Systems[END_REF], and therefore between those who have high and low representation scores.

As in prior research [START_REF] Golder | Ideological Congruence and Electoral Institutions[END_REF][START_REF] Blais | Linking party preferences and the composition of government: A new standard for evaluating the performance of electoral democracy[END_REF], we use three measures of the proportionality of the electoral system: a simple dummy that equals 1 when the electoral formula is proportional, the Gallagher (1991) disproportionality index, and mean district magnitude. For the latter measure, as is usual in the literature, we use a logarithmic transformation of the variable. See Appendix A for more details.

Table 4 shows the relationship between the three indicators of proportionality and our mean representation scores.12 Four of the six coefficients are not significant. The mean score is slightly lower in elections held in large districts, but the difference is substantively small. Appendix G presents the scatter plots for the disproportionality index and district magnitude with respect to the cabinet representation score. These scatter plots confirm the absence of any meaningful systematic relationship between electoral systems and the degree of party preference representation. In short, the results in Table 4 offer no evidence that the overall degree of party preference representation varies across electoral systems. Even though proportional systems do not produce a higher overall mean representation score, we expect them to reduce individual inequalities between voters. That is, that some citizens have a very high score, while others have a very low score. This should be particularly the case for cabinet representation. The reason is simply that more parties are represented in the cabinet under PR. If there are for instance two parties in a coalition government, many voters may strongly like one party and strongly dislike the other and will end up with a middle of the road score while few will have either a very high or a very low score. This is less likely with singleparty governments that are usually found in majoritarian systems. To verify whether proportional rules are associated with lower inequalities in electoral representation scores, we analyze the correlation between our three measures of electoral systems and the standard deviation of citizens' electoral representation scores in each election. Table 5 provides empirical support for our expectation, which suggests that proportional rules are associated with more equal party preference representation scores. Appendix H presents the scatter plots for each of these bivariate relationships, which show no evidence of outlier-driven results. Our findings about the impact of the electoral system are clear. Proportional systems do not enhance the overall degree of party preference representation, but they do reduce differential rates of representation between individuals.

Conclusion

We have proposed a simple measure of the party preference representation that citizens derive from the outcome of an election. That measure is based on two assumptions. First, elections and voting are first and foremost about parties. Second, citizens 'degree of representation in an election is maximized (minimized) when the parties that they like the most are strongly (weakly) represented in the legislature/cabinet.

We have used the CSES data set and computed electoral outcome representation score for each of the 160,000 individuals in the 111 legislative elections held in non-presidential systems. We find that the representation score associated with the partisan composition of the legislature is slightly above the mid-point and is mostly normally distributed while that associated with the partisan composition of the cabinet has peaks around 0 and 1 and has a relatively high mean, reflecting the fact that the parties that are the most liked are overrepresented in government.

We wished to determine whether some socio-demographic groups systematically obtain higher party preference representation scores from electoral outcomes in contemporary democracies. This does not mean that some of these groups do not exercise more power. It does mean, however, that whatever power differential they may enjoy is not the consequence of electoral outcomes, that is, the parties that these groups prefer do not systematically perform better in elections. That power differential, if it exists, occurs independently of elections.

We also ascertain whether some politically defined groups derive greater representation from the partisan composition of the legislature and cabinet. We expected those with extreme views on the left/right dimension to be disadvantaged because the parties that they prefer tend to be less popular among the whole electorate and are also less likely to be invited to be part of a coalition government. We find some support for that expectation though the pattern is weak.

Finally, we find that citizens on the right have higher representation scores than their left-wing counterparts. This is because there are more right-wing than left-wing voters and governments in contemporary democracies. Why this is the case and whether this pattern is likely to change in the future is beyond the goal of this study.

At the aggregate level, proportional systems do not perform better in terms of overall voter representation, but they do reduce inequalities.

We hope to have convinced readers that our measure, which is based on what we believe to be reasonable assumptions (i.e. elections are first and foremost about parties, and one's degree of representation in an election is maximized when the parties she likes the most have many seats in the legislature and cabinet) is a fruitful one and provides new insights about the meaning of electoral outcomes at both the individual and aggregate level.

CSES, and the portfolio share of each party in the cabinet. We multiply the party's portfolio share by its ideology score. We then add the score of each party in a given election. Scaled from 0 to 1.

Representation score (cabinet): We first determine how much respondents like and dislike a party using the following question: "I'd like to know what you think about each of our parties. After I read the name of a political party, please rate it on a scale from 0 to 10, where 0 means you strongly dislike that party and 10 means that you strongly like that party. If I come to a party you haven't heard of or you feel you do not know enough, just say so.". We normalize party ratings so that the highest rated party is given a score of 1 and the lowest rated party a score of 0.

All the other parties are given a score that equals the original score minus the score of the lowestrated party divided by the difference in the scores of the highest and lowest rated parties. We then multiply this score by the parties 'share of cabinet portfolios and add each party's score for a given election. Scaled from 0 to 1.

Representation score (legislature): We first determine how much respondents like and dislike a party using the following question: "I'd like to know what you think about each of our parties. After I read the name of a political party, please rate it on a scale from 0 to 10, where 0 means you strongly dislike that party and 10 means that you strongly like that party. If I come to a party you haven't heard of or you feel you do not know enough, just say so.". We normalize party ratings so that the highest rated party is given a score of 1 and the lowest rated party a score of 0.

All the other parties are given a score that equals the original score minus the score of the lowestrated party divided by the difference in the scores of the highest and lowest rated parties. We then multiply this score by the parties 'share of seats in the legislature and add each party's score for a given election. Scaled from 0 to 1.

Table 1 : Legislative representation and socio-demographics

 1

			DV = legislative representation
	Independent variable	Age	Gender	Education	Income	Rural
		0.002	-0.005	0.010	0.026	-0.003
		(0.007)	(0.002)	(0.004)	(0.004)	(0.003)
	N	159902	160708	158578	129315	140936
	R 2	0.061	0.062	0.062	0.065	0.068

Note: All models include election fixed effects (not shown). Standard errors are robust and clustered by election (shown in parentheses).

Table 2 : Cabinet representation and socio-demographics

 2

			DV = legislative representation
	Independent variable	Age	Gender	Education	Income	Rural
		0.011	-0.007	0.011	0.048	-0.012
		(0.020)	(0.004)	(0.012)	(0.010)	(0.007)
	N	157431	158229	156113	127135	138611
	R 2	0.039	0.039	0.040	0.044	0.043
	Note: All models include election fixed effects (not shown). Standard errors are robust and
	clustered by election (shown in parentheses).

Table 3 : Representation and political orientations

 3

		DV = legislative	DV = cabinet
		representation	representation
	Independent variable	Extremism Left-right Extremism Left-right
		-0.056	0.071	-0.054	0.199
		(0.005)	(0.014)	(0.014)	(0.063)
	N	135380	135380	133722	133722
	R 2	0.079	0.078	0.043	0.061

Note: All models include election fixed effects (not shown). Standard errors are robust and clustered by election (shown in parentheses).

Table 4 . Mean representation and electoral systems

 4

		DV = mean legislative representation	DV = mean cabinet representation
	Independent variable	Proportional	Gallagher index	District magnitude	Proportional	Gallagher index	District magnitude
		-0.021	0.004	-0.052	-0.018	0.007	-0.074
		(0.012)	(0.021)	(0.017)	(0.013)	(0.027)	(0.021)
	Constant	0.562	0.544	0.563	0.616	0.599	0.628
		(0.011)	(0.008)	(0.007)	(0.011)	(0.011)	(0.009)
	N	111	110	111	109	108	109
	R 2	0.028	0.000	0.082	0.008	0.000	0.073

Note: Robust standard errors in parentheses.

Table 5 . The dispersion of representation and electoral systems

 5

		DV= standard deviation of legislative	DV= standard deviation of cabinet
			representation			representation
	Independent variable	Proportional	Gallagher index	District magnitude	Proportional	Gallagher index	District magnitude
		-0.036	0.068	-0.041	-0.084	0.144	-0.111
		(0.005)	(0.011)	(0.009)	(0.016)	(0.026)	(0.024)
	Constant	0.195	0.144	0.180	0.390	0.274	0.359
		(0.005)	(0.005)	(0.004)	(0.014)	(0.011)	(0.010)
	N	111	110	111	109	108	109
	R 2	0.196	0.255	0.127	0.167	0.187	0.152

Note: Robust standard errors in parentheses.

Multiple Imputation: Cabinet representation (unstandardized).

  All models include election fixed effects (not shown). Standard errors are robust and clustered by election (shown in parentheses). Missing party ratings were imputed five times.

	Appendix B. Variable distributions
		0.001	0.008	-0.003	0.022	-0.004	0.071	-0.055
		(0.007)	(0.004)	(0.001)	(0.003)	(0.002)	(0.013)	(0.004)
	N	174420	172097	175475	139196	150836	139986	139986
	Note: Multiple Imputation: Cabinet representation.
		Age	Education	Gender	Income	Rural	Left/Right Extremism
		0.008	0.007	-0.005	0.043	-0.012	0.195	-0.052
		(0.018)	(0.010)	(0.004)	(0.009)	(0.007)	(0.060)	(0.014)
	N	172170	169849	173224	137114	148588	138574	138574
		Age	Education	Gender	Income	Rural	Left/Right Extremism
		0.014	-0.004	0.007	0.012	-0.010	0.084	0.007
	Absolute Representation score (cabinet): We first determine how much respondents like and (0.007) (0.005) (0.001) (0.003) (0.003) (0.012) (0.004)
	dislike a party using the following question: "I'd like to know what you think about each of our parties. After I read the name of a political party, please rate it on a scale from 0 to 10, where 0 N 179141 176797 180257 142491 155153 142885 142885
	means you strongly dislike that party and 10 means that you strongly like that party. If I come to
	a party you haven't heard of or you feel you do not know enough, just say so.". We then multiply
	this score by the parties 'share of cabinet portfolios and add each party's score for a given
	election. Scaled from 0 to 1.
	Absolute Representation score (legislature): We first determine how much respondents like and Age Education Gender Income Rural Left/Right Extremism
	dislike a party using the following question: "I'd like to know what you think about each of our 0.026 -0.006 0.007 0.026 -0.014 0.185 0.021 parties. After I read the name of a political party, please rate it on a scale from 0 to 10, where 0 means you strongly dislike that party and 10 means that you strongly like that party. If I come to (0.014) (0.008) (0.002) (0.007) (0.005) (0.049) (0.011)
	a party you haven't heard of or you feel you do not know enough, just say so.". We then multiply N 176820 174478 177935 140344 152830 141436 141436
	this score by the parties 'share of seats in the legislature and add each party's score for a given Note: All models include election fixed effects (not shown). Standard errors are robust and clustered by election (shown
	election. Scaled from 0 to 1. in parentheses). Missing party ratings were imputed five times.
	Standard deviation of representation score (cabinet): The standard deviation of the representation
	score (cabinet).

Standard deviation of representation score (legislature): The standard deviation of the representation score (legislature).

Note: All models include election fixed effects (not shown). Standard errors are robust and clustered by election (shown in parentheses). Missing party ratings were imputed five times.

Multiple Imputation: Legislative representation (unstandardized).

Note: All models include election fixed effects (not shown). Standard errors are robust and clustered by election (shown in parentheses). Missing party ratings were imputed five times.

Appendix F.

Mean representation scores and standard deviations for each election

	64. Austria 2008 2. Mean representation (legislature) scores and standard deviations for each election 0.624 0.267 88. Bulgaria 2001 0.668 67. United Kingdom 1997 0.554 0.215 102. Ireland 2007 0.608	0.274 0.205
	65. Australia 2007 68. Norway 1997 1. Mean representation (cabinet) scores and standard deviations for each election 0.625 0.425 89. Sweden 2014 0.669 0.554 0.135 103. Iceland 2007 0.609 66. Australia 2004 0.628 0.382 90. New Zealand 2011 0.675 Score Sd. 33. Turkey 2011 0.518 Election (Legislative) (Legislative) 69. Canada 2011 0.554 0.222 104. New Zealand 2008 0.612	0.265 0.149 0.408 0.216 0.160
				34. Norway 2001	0.518	0.115
	Election 67. Poland 2011 1. Bulgaria 2014 70. Spain 2008	(cabinet) Score 0.630 0.409 0.555	(cabinet) Sd. 0.325 0.160 0.178	35. Finland 2003 32. Czech Republic 1996 91. Poland 2007 105. South Africa 2009	0.520 0.559 0.678 0.617	0.151 0.307 0.317 0.236
	68. Thailand 2001 2. Greece 2012 71. Denmark 1998	0.632 0.440 0.557	0.294 0.184 0.140	33. Iceland 2003 92. Czech Republic 2002 106. Japan 1996	0.560 0.679 0.618	0.325 0.260 0.220
	1. Slovenia 2011	0.400	0.263	36. Czech Republic 2002	0.521	0.124
	69. Denmark 1998 3. Montenegro 2012 72. Australia 1996	0.634 0.452 0.558	0.353 0.182 0.195	34. Finland 2003 93. Portugal 2005 107. Australia 2004	0.560 0.683 0.619	0.205 0.368 0.198
	2. Greece 2012	0.455	0.311	37. Spain 1996	0.522	0.181
	70. Ireland 2007 4. Slovakia 2016 73. Sweden 2014	0.634 0.459 0.559	0.326 0.162 0.106	35. United Kingdom 2005 94. Poland 2005 108. Ireland 2011	0.562 0.685 0.621	0.459 0.356 0.195
	3. Spain 1996	0.456	0.451	38. Iceland 2013	0.524	0.166
	71. Belgium (F) 1999 5. Slovenia 2011 74. Denmark 2007	0.635 0.461 0.559	0.219 0.167 0.125	36. Portugal 2002 95. Spain 2008 109. Germany 2013	0.563 0.685 0.621	0.380 0.387 0.181
	4. Slovenia 1996	0.460	0.247	39. Austria 2013	0.525	0.147
	72. Belgium (F) 2003 6. Czech Republic 2010 75. Thailand 2011	0.638 0.464 0.562	0.282 0.139 0.168	37. Czech Republic 2003 96. New Zealand 2008 110. Belgium (W) 1999	0.565 0.686 0.627	0.230 0.384 0.186
	5. Slovenia 2004	0.477	0.270	40. Canada 2008	0.526	0.182
	73. Norway 2005 7. Czech Republic 2013 76. Sweden 2002	0.639 0.473 0.563	0.211 0.132 0.125	38. Norway 2013 97. New Zealand 2002 111. France 2007	0.566 0.689 0.668	0.295 0.357 0.194
	6. Czech Republic 2010	0.478	0.319	41. Sweden 1998	0.526	0.129
	74. Austria 2013 8. Latvia 2014 77. Denmark 2001	0.640 0.475 0.564	0.247 0.138 0.124	39. Netherlands 1998 98. Iceland 2007	0.568 0.691	0.209 0.213
	7. Latvia 2011	0.487	0.283	42. Serbia 2012	0.528	0.154
	75. Netherlands 2010 9. Slovenia 2004 78. Netherlands 1998	0.644 0.484 0.567	0.240 0.170 0.155	40. Finland 2007 99. South Africa 2014	0.568 0.693	0.228 0.404
	8. Slovakia 2010	0.494	0.270	43. Greece 2015	0.528	0.184
	76. Germany 2002 10. Czech Republic 2006 79. Netherlands 2010	0.644 0.484 0.568	0.308 0.150 0.115	41. Portugal 2015 100. Canada 1997	0.572 0.694	0.405 0.344
	9. Croatia 2007	0.498	0.356	44. Belgium (F) 2003	0.532	0.144
	77. United Kingdom 1997 11. Italy 2006 80. Hungary 2002	0.645 0.488 0.570	0.427 0.149 0.150	42. United Kingdom 2015 101. Ireland 2002	0.575 0.696	0.429 0.336
	10. Italy 2006	0.503	0.352	45. Romania 2004	0.533	0.150
	78. Netherlands 2006 12. Israel 2006 81. Portugal 2005	0.647 0.492 0.570	0.187 0.143 0.190	43. Poland 1997 102. France 2007	0.576 0.696	0.346 0.322
	11. Czech Republic 2006	0.503	0.436	46. Iceland 2003	0.534	0.135
	79. Sweden 1998 13. United Kingdom 2005 82. Australia 2007	0.648 0.493 0.573	0.373 0.185 0.178	44. Netherlands 2002 103. New Zealand 2014	0.580 0.697	0.219 0.390
	12. Montenegro 2012	0.510	0.443	47. Latvia 2010	0.534	0.161
	80. Norway 2009 14. Slovenia 1996 83. Romania 2012	0.648 0.495 0.574	0.234 0.153 0.210	45. Israel 2003 104. Romania 2012	0.581 0.705	0.281 0.333
	13. Belgium (W) 2003	0.512	0.182	48. Poland 2007	0.536	0.139
	81. Germany 2013 15. Croatia 2007 84. Canada 2015	0.651 0.495 0.575	0.228 0.186 0.214	46. Hungary 2002 105. Ireland 2011	0.582 0.709	0.413 0.267
	14. Slovakia 2016	0.521	0.311	49. Bulgaria 2001	0.536	0.154
	82. Thailand 2011 16. Slovenia 2008 85. Germany 2005	0.651 0.499 0.576	0.406 0.195 0.153	47. Portugal 2009 106. Greece 2009	0.583 0.709	0.421 0.354
	15. Germany 2009	0.523	0.319	50. Canada 1997	0.537	0.169
	83. Belgium (W) 1999 17. Portugal 2009 86. Portugal 2002	0.660 0.501 0.580	0.197 0.186 0.207	48. Australia 1996 107. Spain 2004	0.589 0.714	0.388 0.374
	16. Estonia 2011	0.523	0.351	51. Poland 2005	0.538	0.172
	84. Greece 2015 18. Portugal 2015 87. Iceland 1999	0.661 0.505 0.582	0.383 0.181 0.151	49. Denmark 2007 108. Sweden 2002	0.590 0.714	0.318 0.336
	17. Latvia 2014	0.526	0.256	52. Finland 2007	0.539	0.157
	85. Spain 2000 19. Latvia 2011 88. Norway 2005	0.664 0.505 0.582	0.425 0.155 0.116	50. Hungary 1998 109. South Africa 2009	0.592 0.726	0.290 0.398
	18. Israel 1996	0.526	0.355	53. Poland 2001	0.542	0.209
	86. Turkey 2011 20. Estonia 2011 89. Greece 2009	0.667 0.505 0.586	0.434 0.156 0.202	51. Sweden 2006	0.596	0.267
	19. Finland 2011	0.528	0.167	54. Belgium (F) 1999	0.543	0.136
	87. Germany 1998 21. Israel 2003 90. Germany 1998	0.668 0.507 0.591	0.288 0.155 0.160	52. Canada 2008	0.598	0.424
	20. Norway 1997	0.531	0.251	55. Spain 2004	0.546	0.153
	22. Poland 1997 91. Norway 2009	0.509 0.595	0.158 0.123	53. Albania 2005	0.600	0.332
	21. Bulgaria 2014	0.533	0.334	56. Iceland 2009	0.547	0.147
	23. Czech Republic 1996 92. Spain 2000	0.509 0.595	0.133 0.213	54. Poland 2001	0.601	0.348
	22. Finland 2015	0.540	0.236	57. Israel 1996	0.547	0.141
	24. Ukraine 1998 93. Norway 2013	0.510 0.598	0.206 0.129	55. Latvia 2010	0.609	0.277
	23. Israel 2006	0.540	0.269	58. United Kingdom 2015	0.548	0.219
	25. Canada 2004 94. South Africa 2014	0.510 0.598	0.168 0.222	56. Germany 2005	0.613	0.195
	24. New Zealand 1996	0.542	0.304	59. Romania 1996	0.548	0.152
	26. Finland 2015 95. New Zealand 2011	0.511 0.599	0.151 0.160	57. Iceland 1999	0.614	0.290
	25. Slovenia 2008	0.549	0.301	60. Australia 2013	0.549	0.197
	27. Albania 2005 96. Netherlands 2006	0.512 0.601	0.150 0.132	58. Canada 2004	0.615	0.397
	26. Iceland 2013	0.550	0.353	61. Belgium (W) 2003	0.550	0.235
	28. Germany 2009 97. Ireland 2002	0.513 0.601	0.149 0.194	59. Iceland 2009	0.616	0.298
	27. Canada 2011	0.552	0.451	62. New Zealand 2002	0.551	0.152
	29. Poland 2011 98. Germany 2002	0.515 0.602	0.164 0.155	60. Serbia 2012	0.618	0.235
	28. Norway 2001	0.556	0.213	63. Slovakia 2010	0.552	0.143
	30. Austria 2008 99. New Zealand 2014	0.515 0.603	0.146 0.172	61. Japan 1996	0.620	0.271
	29. Australia 2013	0.556	0.425	64. New Zealand 1996	0.553	0.155
	31. Finland 2011 100. Sweden 2006	0.515 0.604	0.137 0.140	62. Denmark 2001	0.621	0.297
	30. Israel 2013	0.557	0.243	65. Netherlands 2002	0.553	0.129
	32. Israel 2013 101. Thailand 2001	0.516 0.604	0.154 0.187	63. Canada 2015	0.623	0.389
	31. Romania 2004	0.558	0.270	66. Hungary 1998	0.553	0.152
	36

They may also have strategic considerations. This is why we use party ratings rather than vote choice as the reference point since they more directly reflect citizens' preferences.

We are agnostic about what makes a person like some parties and dislike others. These preferences can reflect assessments of the parties' policy positions on the major issues of the day, their perceived competence or honesty, evaluations of the party leader or traditional loyalties. Regardless of what causes a voter to like or dislike each party, these ratings indicate her set of preferences among the available options.

We exclude respondents who rated all parties equally. In an alternative version of our measure, we do not normalize preferences to the [0,1] interval, which allows us to keep all respondents. Our substantive results remain similar with this alternative measure.

Those who give systematically high (low) scores may also be signaling that they like (dislike) all the options. This possibility is accounted for with the alternative (unstandardized) measure that is presented below.

We use the share of seats based on the set of parties which a given respondent has rated. If a respondent fails to rate party A, then the seats won by A are excluded from the total number of seats used to calculate seat shares when we compute our measure for this particular respondent.

The data for seat share in the legislature and cabinet and district magnitude were taken from the individual CSES modules, as these variables are not included in the IMD dataset.

See Branham, Soroka and Wlezien (2017) for a similar argument that inequalities in policy representation are limited.

Within the period covered by our dataset, there is no evidence that the performance of right-wing parties has improved over time; the mean cabinet ideology score is 0.5 in each of the four modules.

Appendix F presents the mean representation score and standard deviation for each individual election.

We believe that our measure captures a crucial aspect of representation in an electoral democracy. One is more likely to feel well represented when the party she prefers has many seats in the legislature and cabinet. This is, of course, only one dimension of representation. One is also more likely to feel well represented when the policies she prefers are adopted and implemented by the government. This is policy representation. It is possible to have strong electoral outcome representation and weak policy representation or the reverse. Both types of representation deserve close examination.

Appendix A. Question wording and coding

Age: Continuous measure rescaled from 0 to 1.

Gender: Based on self-identification. 1= woman, 0 = man. Education: Reports the respondent's highest level of completed education. The options were "None, Early childhood education, Primary, Lower secondary, Upper secondary, Postsecondary, Short-cycle tertiary, Bachelor or equivalent, Master or equivalent, Doctoral or equivalent." Rescaled from 0 to 1, where 1 is doctoral or equivalent.

Income: Reports the annual household income quintile in which the respondent's household falls. Rescaled from 0 to 1, where 1 is the highest household income quintile.

Rural/Urban: Reports the respondent's place of residence. The options are "rural area or village, small or middle-sized town, suburbs of large town or city, large town or city". Rescaled from 0 to 1, where 0 is large town or city and 1 is rural area or village.

Ideology (individual): Reports the respondent's location on the political spectrum. The question was: "In politics people sometimes talk of left and right. Where would you place yourself on a scale from 0 to 10, where 0 means the left and 10 means the right?" Rescaled from 0 to 1, where 1 is the right.

Extremism: Extremism is measured based on a survey question asking the respondents to selfdetermine their political ideology on the left-right scale. The question was: "In politics people sometimes talk of left and right. Where would you place yourself on a scale from 0 to 10, where 0 means the left and 10 means the right?" We use the absolute difference between the voter's position and the center, creating a variable ranging from 0 to 5. Rescaled from 0 to 1, where 1 is respondents located at 0 or 10.

Proportional representation: Reports the electoral system used for each election. Elections are coded as 1 if the electoral system is PR, alternative vote or mixed member proportional and they are coded as 0 if the electoral system is majoritarian or mixed parallel. We use Matt Golder's Democratic Electoral Systems (DES) version 3.0 dataset.

Gallagher index: The data are taken from Michael Gallagher's dataset. For the elections not included in Gallagher's dataset, the index is calculated using the vote share and seat share variables in the CSES dataset. Rescaled from 0 to 1, where 1 is the most disproportional outcome.

District magnitude: Represents the logarithmic transformation of the district magnitude for each election. The district magnitude is calculated by dividing the total number of seats by the total number of districts in all tiers. Rescaled from 0 to 1, where 1 is the biggest district magnitude. Ideology (cabinet): Represents the score of the cabinet on the ideological spectrum. This variable is created using the expert judgement of the parties 'position on a left-right scale included in the

Appendix C. Multivariate analysis of the representation scores


Cloe Comarmond
email: clocomarmond@yahoo.fr

David Saadoun

Jacky Nizard

MD Patrice Cacoub
email: patrice.cacoub@aphp.fr

MD Cloé Comarmond

Pregnancy issues in Takayasu arteritis

Keywords:

Takayasu arteritis (TAK) is a chronic inflammatory vasculitis of unknown origin affecting large vessels, predominantly the aorta and its main branches. TAK usually affects young women and the management of pregnancy during this vasculitis may be a challenging situation. After a review of the literature, we analysed the data of 505 pregnancies in 373 TAK patients. We discuss main results to clarify if the pregnancy outcome is affected by TAK, especially during disease clinical onset or disease activity. We also discuss the potential impact of pregnancy on TAK prognosis. Disease activity of TAK appears independently associated with a poor pregnancy outcome. More than 5% of pregnant women with TAK develop a life-threatening maternal cardiovascular complication. A good control of TAK disease activity and arterial hypertension before conception and during pregnancy is critical to improve both maternal and foetal outcomes. Pregnancies in the setting of TAK should be considered high-risk, requiring a close collaboration between specialists involved in the care of TAK and obstetricians.

Takayasu arteritis (TAK) typically occurs in young women during childbearing age [START_REF] Kerr | Takayasu arteritis[END_REF]. Therefore, it is more common to observe pregnancy in TAK patients than in patients with other systemic vasculitis [START_REF] Machen | Vasculitis and Pregnancy[END_REF]. Pregnancy may affect the diagnosis, management, and outcome of TAK. Interestingly, profound modifications of the hormonal and cytokine microenvironment occur during pregnancy. Some physiologic adaptive changes of the cardiovascular system, such as increased circulating blood volume and increased cardiac load, superimposed on an acute ongoing inflammatory process in the vasculature may contribute to the deterioration of vascular lesions in a pregnant woman with TAK. Moreover, variations in maternal cytokines during pregnancy, such as elevated IL-6 and TNF frequently observed during infection or inflammatory disease, could be associated with increased risk of preterm birth [START_REF] Ferguson | Longitudinal profiling of inflammatory cytokines and C-reactive protein during uncomplicated and preterm pregnancy[END_REF]. This review aimed at discussing the maternal management and obstetrical outcome, based on the data obtained after a literature review.

Methods

We used the terms "pregnancy", "obstetrical complication", "Takayasu arteritis", and "Takayasu" in the PubMed Database, and we searched main articles published in the literature from 1980 to 2019. We analysed pregnancies in TAK patients from cohort studies including at least 5 pregnancies. Cases reports and small cases series with less than 5 pregnancies were excluded.

Results

We found 183 citations in the PubMed Database until March 2020. All articles with sufficient data in English language were included in the literature review. We analysed the data of 505 pregnancies in 373 TAK patients. Table 1 summarizes main results obtained in studies reporting obstetrical outcome for at least 5 patients. A live birth was reported in 84% of pregnancies, eclampsia or preeclampsia in 24%, preterm live birth in 15% and miscarriage in 12%.

Pregnancy outcome before established TAK disease

Takayasu arteritis can have a preclinical period and a long prodromal phase. Few studies described foetal and maternal outcomes in women before TAK diagnosis (4-9). However, none of these studies analysing pregnancies before established TAK disease described inflammation markers or vascular imaging. So, pregnancies during prodromal phase or truly before diagnosis remain difficult to distinguish. Gudbranson et al described 73 pregnancies in 33 patients before TAK diagnosis [START_REF] Gudbrandsson | Takayasu Arteritis and Pregnancy: A Population-Based Study on Outcomes and Mother/Child-Related Concerns[END_REF]. The frequencies of miscarriages, induced abortions, and maternal complications did not differ between pregnancies occurring before and after TAK onset [START_REF] Gudbrandsson | Takayasu Arteritis and Pregnancy: A Population-Based Study on Outcomes and Mother/Child-Related Concerns[END_REF]. Among 25 pregnancies occurring before the diagnosis of TAK was done, 15 live births, 6 early miscarriages, and 4 voluntary terminations of pregnancy were observed (8).

Wong et al described 11 pregnancies before TAK diagnosis which were all uneventful (4). On the contrary, Assad et al identified that patients with TAK, even before the disease diagnosis, have a worse foetal outcome that were most likely associated with high rates of hypertension, suggesting that pre-disease diagnosis may be eventful in terms of reproductive history [START_REF] Assad | Maternal and Neonatal Outcomes in 89 Patients with Takayasu Arteritis (TA): Comparison Before and After the TA Diagnosis[END_REF].

Women with unknown diagnosis of TAK and delay in TAK diagnosis are very frequent. As in other rheumatologic diseases (rheumatoid arthritis, lupus erythematosus, scleroderma, antiphospholipid syndrome), TAK may remain quiet or asymptomatic until pregnancy, period during which TAK disease may become more aggressive, putting both mother and foetus high-risk. The risk of gestational hypertension, preeclampsia, or eclampsia in pregnant women before TAK diagnosis seems to be lower than during pregnancies at same time or after TAK diagnosis. Among 142 pregnancies occurring in 52 patients before TAK diagnosis, obstetrical complications before 37 weeks of gestation occurred in 6% of pregnancies before TAK diagnosis compared to 40% of pregnancies at the same time or after TAK diagnosis [START_REF] Comarmond | Takayasu Arteritis and Pregnancy[END_REF].

A Brazilian study found that pregnancies before TAK diagnosis had high rates of hypertension (27%), more frequent low birth weight (17%), and perinatal mortality around 8% [START_REF] Assad | Maternal and Neonatal Outcomes in 89 Patients with Takayasu Arteritis (TA): Comparison Before and After the TA Diagnosis[END_REF]. Pregnant patients before TAK diagnosis with arterial hypertension presented more frequently caesarean rate, prematurity and low birth weight than the group without hypertension [START_REF] Assad | Maternal and Neonatal Outcomes in 89 Patients with Takayasu Arteritis (TA): Comparison Before and After the TA Diagnosis[END_REF]. In this study, hypertension represented the most common pregnancy complication among patients who had a TAK diagnosis before the pregnancy. The occurrence of hypertension during pregnancy before TAK was similar to the rate described in patients with established TAK diagnosis while it was about 7 times higher than in healthy control group. This finding suggests that these women were already pregnant, with TAK still undiagnosed (9).

Pregnancy outcome in patients with established Takayasu arteritis

Obstetric complications, such as gestational hypertension, preeclampsia, spontaneous abortion, intrauterine growth retardation (IUGR), preterm birth, and caesarean section seem to be more frequent in pregnancies of patients with TAK. Among 379 pregnancies in 294 Takayasu arteritis patients from studies of different countries, high rate of maternal complication and poor pregnancy outcomes were reported. In patients with TAK, hypertension disorders are observed in 35%, caesarean section in 30%, prematurity in 16%, IUGR in 15%, foetal loss in 12%, and therapeutic abortions in 7% (Table 1). In general population, pregnancy hypertension occurs in 3 to 9%, pre-eclampsia in 1 to 4%, caesarean section in 6 to 20%, preterm birth in 5 to 7%, and IUGR in 3 to 7%.

The most common complication in pregnant patients with TAK was hypertension with an overall incidence reaching 35%. The timing of therapy, the severity of hypertension, and the extent of arterial involvement were predictive of IUGR (4). Sharma et al reported that patients with poor perinatal outcome had abdominal aortic involvement and a significant delay in seeking medical attention [START_REF] Sharma | Outcome of pregnancy in Takayasu arteritis[END_REF]. Pregnancies in women with TAK diagnosis had higher rate of obstetric complications compared to pregnancies before TAK diagnosis [START_REF] Wong | Pregnancy and Takayasu's arteritis[END_REF][START_REF] Comarmond | Takayasu Arteritis and Pregnancy[END_REF][START_REF] Alpay-Kanitez | Favourable pregnancy outcome in Takayasu arteritis: a single centre experience[END_REF]. Obstetric complications were observed in 40% of pregnancies at the same time or after TAK diagnosis, including hypertension/preeclampsia (21%), miscarriage (9%), prematurity (8%), IUGR or foetal death (5%), and eclampsia (3%). Three neonatal deaths were observed in 2 patients: 2 stillbirths after eclampsia and 1 neonatal death that occurred 48 hours following a delivery at 27 weeks due to severe intrauterine growth restriction and placental ischemia [START_REF] Comarmond | Takayasu Arteritis and Pregnancy[END_REF]. Kirshenbaum et al reported 8 out of 13 (61.5%) pregnant women suffering from hypertension during their pregnancy [START_REF] Kirshenbaum | Pregnancy outcome in patients with Takayasu's arteritis: cohort study and review of the literature[END_REF]. Chronic hypertension was observed in 2 patients prior to conception. Elevation in blood pressure began at the third trimester in other cases. Blood pressure was controlled with labetolol and nifedipine. Two out of 13 cases required hospitalization during pregnancy for evaluation and management of hypertension [START_REF] Kirshenbaum | Pregnancy outcome in patients with Takayasu's arteritis: cohort study and review of the literature[END_REF]. Four patients had premature delivery due to active TAK disease (n=2), preeclampsia (n=1) and IUGR with abnormal fetal arterial flow (n=1) [START_REF] Kirshenbaum | Pregnancy outcome in patients with Takayasu's arteritis: cohort study and review of the literature[END_REF]. Different factors associated with maternal and foetal complications and adverse outcomes have been reported. Suri et al described that abdominal aorta involvement is associated poor obstetric outcome [START_REF] Suri | Pregnancy and Takayasu arteritis: a single centre experience from North India[END_REF]. We reported that factors associated with risks of obstetric and maternal complications were smoking and active TAK disease with an NIH score >1 (5). Abisror et al also reported a high rate of obstetrical complications (47%) in women with Takayasu arteritis [START_REF] Abisror | Analysis of risk factors for complications and adverse obstetrical outcomes in women with Takayasu arteritis: a French retrospective study and literature review[END_REF]. Obstetrical complications included 35% of arterial hypertension (n = 15), 9% of pre-eclampsia (n = 4), 2% of HELLP syndrome (n = 1) and 14% of IUGR (n = 6), leading in one case to a medically indicated termination of pregnancy. Obstetrical complications were more frequent in TAK patients with arterial hypertension, renal artery stenosis and infra-diaphragmatic artery involvement [START_REF] Abisror | Analysis of risk factors for complications and adverse obstetrical outcomes in women with Takayasu arteritis: a French retrospective study and literature review[END_REF]. Despite frequent obstetrical complications, no significant impact was observed on live birth rates with 98% of live births.

A small number of studies reported excellent maternal outcomes and favourable foetal outcomes [START_REF] Gudbrandsson | Takayasu Arteritis and Pregnancy: A Population-Based Study on Outcomes and Mother/Child-Related Concerns[END_REF][START_REF] Hidaka | Clinical manifestations of pregnancy in patients with Takayasu arteritis: experience from a single tertiary center[END_REF][START_REF] Tanaka | Analysis of pregnancies in women with Takayasu arteritis: complication of Takayasu arteritis involving obstetric or cardiovascular events[END_REF]. However, these series included only TAK patients who became pregnant during remission of the vasculitis. Only 2 cases (2/18, 11%) of superimposed pregnancy-induced hypertension were included [START_REF] Hidaka | Clinical manifestations of pregnancy in patients with Takayasu arteritis: experience from a single tertiary center[END_REF]. No case with aortic aneurysm, cardiac failure, coronary involvement or pulmonary arteries involvement were described [START_REF] Hidaka | Clinical manifestations of pregnancy in patients with Takayasu arteritis: experience from a single tertiary center[END_REF]. In addition, post-partum period in TAK patient is usually uncomplicated.

Impact of pregnancy on Takayasu arteritis

The impact of pregnancy on Takayasu's disease remains unclear. The most frequently observed maternal complication during pregnancy of TAK patients is hypertensive disorder.

Nevertheless, gestational hypertension is present in about 1:15 pregnancies and can occur independently of TAK disease. Rare fatal maternal complications have been reported such as aortic aneurysm and cerebral haemorrhage [START_REF] Wong | Pregnancy and Takayasu's arteritis[END_REF][START_REF] Suri | Pregnancy and Takayasu arteritis: a single centre experience from North India[END_REF]. Manifestations of TAK disease described during pregnancy are various, such as renal insufficiency, retinopathy, aortic dissection, cerebrovascular accidents and cardiac insufficiency [START_REF] Sharma | Outcome of pregnancy in Takayasu arteritis[END_REF][START_REF] Jayet | Management of a Thoracic Aortic Aneurysm during Pregnancy Leading to the Diagnosis of Takayasu Arteritis[END_REF][START_REF] Jacquemyn | Pregnancy and Takayasu's arteritis of the pulmonary artery[END_REF][START_REF] Lakhi | Takayasu's arteritis in pregnancy complicated by peripartum aortic dissection[END_REF]. Symptoms of TAK may respond variably during pregnancy. Some patients had worsening of their symptoms during pregnancy while others had milder symptoms than they had had prior to pregnancy [START_REF] Kirshenbaum | Pregnancy outcome in patients with Takayasu's arteritis: cohort study and review of the literature[END_REF][START_REF] Hauth | Takayasu's syndrome in pregnancy[END_REF]. Among 98 pregnancies in TAK patients, maternal complications were observed in 39%, including specific TAK complications [START_REF] Comarmond | Takayasu Arteritis and Pregnancy[END_REF]. The most frequent maternal complications were new-onset arterial hypertension (15%), worsening arterial hypertension (11%), and arterial stenosis/occlusion (8%). More than 5% of pregnant women with TAK develop a lifethreatening maternal cardiovascular complication such as aortic aneurysm, stroke, end-stage renal disease [START_REF] Comarmond | Takayasu Arteritis and Pregnancy[END_REF][START_REF] Jayet | Management of a Thoracic Aortic Aneurysm during Pregnancy Leading to the Diagnosis of Takayasu Arteritis[END_REF]. During pregnancy, TAK may arise de novo, and pre-existing vascular symptoms and/or arterial lesions of TAK may be significantly worsened and may potentially become life-threatening [START_REF] Jayet | Management of a Thoracic Aortic Aneurysm during Pregnancy Leading to the Diagnosis of Takayasu Arteritis[END_REF][START_REF] Lakhi | Takayasu's arteritis in pregnancy complicated by peripartum aortic dissection[END_REF][START_REF] Rocha | Massive hemoptysis in Takayasu's arteritis during pregnancy[END_REF]. Severe maternal vasculitis related complications can be observed during pregnancy, including cardiac failure, cerebral ischemia, transient ischemic attack, instances of end-stage renal disease, aortic aneurysms, aortic dissection, haemoptysis) [START_REF] Wong | Pregnancy and Takayasu's arteritis[END_REF][START_REF] Comarmond | Takayasu Arteritis and Pregnancy[END_REF][START_REF] Jayet | Management of a Thoracic Aortic Aneurysm during Pregnancy Leading to the Diagnosis of Takayasu Arteritis[END_REF][START_REF] Rocha | Massive hemoptysis in Takayasu's arteritis during pregnancy[END_REF]. In the literature, three cases of maternal mortality are reported, following myocardial infarction, cerebrovascular accident and stroke [START_REF] Wong | Pregnancy and Takayasu's arteritis[END_REF][START_REF] Gudbrandsson | Takayasu Arteritis and Pregnancy: A Population-Based Study on Outcomes and Mother/Child-Related Concerns[END_REF][START_REF] Mandal | Takayasu arteritis in pregnancy: an analysis from eastern India[END_REF].

High blood pressure in the late gestational period, abdominal and renal involvement, disease activity during the early pregnancy, and delay in medical attention are described as predictive factors of poor outcome [START_REF] Aso | Clinical gynecologic features of pregnancy in Takayasu arteritis[END_REF]. Disease activity of TAK could be associated with a poor pregnancy outcome [START_REF] Comarmond | Takayasu Arteritis and Pregnancy[END_REF][START_REF] Suri | Pregnancy and Takayasu arteritis: a single centre experience from North India[END_REF][START_REF] Tanaka | Analysis of pregnancies in women with Takayasu arteritis: complication of Takayasu arteritis involving obstetric or cardiovascular events[END_REF]. Disease activity is assessed using the NIH definitions, which include 4 components: systemic features (no other cause identified); elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) level; features of vascular ischemia or inflammation (such as extremity claudication, diminished or absent pulse, bruits, pain over large vessels, or asymmetric blood pressure); and new vascular lesion(s) on imaging studies, i.e., new stenosis or new dilatation [START_REF] Kerr | Takayasu arteritis[END_REF]. Active disease is defined as the new onset of 2 or more of these features. However, ESR elevation is a part of normal pregnancies and complicates determining disease activity by NIH criteria. In our experience, active disease (NIH score ≥ 2) was observed in 39 pregnancies (40%) whereas inactive disease (NIH score ≤ 1) was observed in 59 pregnancies (60%). Obstetric complications were more frequent in women with active versus inactive TAK disease (64% versus 24%; P < 0.0001). Preeclampsia was more frequent in pregnant women with active than in pregnant women with inactive disease (46% versus 5%; P < 0.0001). Overall, complications during pregnancy were 3 times more likely to occur in women with active than in those with inactive TAK disease (5). Tanaka et al observed relapse of TAK in five pregnancies (5/22, 23%) [START_REF] Tanaka | Analysis of pregnancies in women with Takayasu arteritis: complication of Takayasu arteritis involving obstetric or cardiovascular events[END_REF]. Two relapses occurred in the first trimester, and both resulted in a miscarriage. The remaining three relapses occurred in the last trimester, including 2 with IUGR. Suri et al found that the incidence of maternal and foetal complications was higher among TAK patients with more severe disease (according to the Ishikawa criteria) and/or with a greater number of damaged vessels [START_REF] Suri | Pregnancy and Takayasu arteritis: a single centre experience from North India[END_REF].

Pregnancy has also been reported to neither interfere with TAK disease progression nor negatively affect fertility [START_REF] Assad | Maternal and Neonatal Outcomes in 89 Patients with Takayasu Arteritis (TA): Comparison Before and After the TA Diagnosis[END_REF][START_REF] Sharma | Outcome of pregnancy in Takayasu arteritis[END_REF][START_REF] Hidaka | Clinical manifestations of pregnancy in patients with Takayasu arteritis: experience from a single tertiary center[END_REF][START_REF] Mandal | Takayasu arteritis in pregnancy: an analysis from eastern India[END_REF][START_REF] Matsumura | Pregnancy in Takayasu arteritis from the view of internal medicine[END_REF]. Rare cases of TAK improvement during pregnancies have been reported [START_REF] Hauth | Takayasu's syndrome in pregnancy[END_REF][START_REF] Matsumura | Pregnancy in Takayasu arteritis from the view of internal medicine[END_REF]. No adverse influence of pregnancy and delivery on Takayasu arteritis was observed in the puerperium of any patients. Inflammatory activity of the disease was not enhanced by the pregnancy [START_REF] Ishikawa | Occlusive thromboaortopathy (Takayasu's disease) and pregnancy. Clinical course and management of 33 pregnancies and deliveries[END_REF]. Matsumura et al reported that CRP levels improved significantly during pregnancy and 1 year after delivery. Hemodynamic state (pulse amplitude and wave) also improved with pregnancy [START_REF] Matsumura | Pregnancy in Takayasu arteritis from the view of internal medicine[END_REF]. In a recent study, no correlation was reported between TAK activity and any of the obstetrical complications (8).

Management of pregnancy and labour in patients with TAK

The under diagnosis of TAK can lead to worse pregnancy and foetal outcome, most likely associated with hypertension. TAK should be identified as an important differential diagnosis for hypertension in pregnancy. Physical examination could be sufficient to alert to the presence of this disease. Headaches, a blood pressure discrepancy, a pulselessness of unilateral or both radial arteries, vascular bruit or limb weakness should be looked at in all cases of hypertension [START_REF] Comarmond | Takayasu Arteritis and Pregnancy[END_REF][START_REF] Suri | Pregnancy and Takayasu arteritis: a single centre experience from North India[END_REF].

Discussion of contraception and pregnancy intentions with patients since multiple teratogenic medications are used to treat TAK and contraception allows for appropriate timing of pregnancy. Preconceptional conselling to assess disease activity, to optimize control of blood pressure and to eventually change medication compatible with pregnancy prior to conception are recommended. Ideally, pregnancy should be planned when TAK disease is in sustained remission. The patient can be off treatment or on a stable therapeutic maintenance regimen that allows conception and must be continued during pregnancy. Medications prior to pregnancy, such as methotrexate, mycophenolate mofetil, cyclophosphamide and angiotensin converting enzyme inhibitor should be avoided during pregnancy. This highlights the importance of pre-pregnancy consultations with obstetricians and specialists of TAK disease (internists/rheumatologists) to review medications, switch potentially teratogenic medications with those considered safe during pregnancy, and ensure disease stability prior to conception to ensure favourable outcomes. To ensure better compliance, physician need to reassure patient concerning many medications used for TAK disease and considered as low risk such as prednisone, azathioprine, and tumour necrosis factor inhibitors (anti-TNFα). Ideally, pregnancy should be planned when the TAK disease is in remission. Antenatal counselling need shape medical treatment for maintaining disease remission prior to conception. For patients flaring during pregnancy, we recommend to intensify medical treatment according to the severity of flare. Suppression of inflammatory syndrome due to TAK disease with glucocorticoids associated to immunosuppressants if necessary, is a cornerstone to improve outcome during pregnancy [START_REF] Hidaka | Clinical manifestations of pregnancy in patients with Takayasu arteritis: experience from a single tertiary center[END_REF][START_REF] Hoffman | Treatment of glucocorticoid-resistant or relapsing Takayasu arteritis with methotrexate[END_REF]. Monitoring and ensuring satisfactory blood pressure control with calcium-channel blockers and/or methyldopa, are also essential. When TAK disease is severe, glucocorticoids associated to azathioprine or anti-TNFα are indicated. Life threatening condition can lead to consider therapeutic abortion or premature delivery.

Control of TAK disease activity and of arterial hypertension before conception and during pregnancy is critical to optimize both maternal and foetal outcomes [START_REF] Comarmond | Takayasu Arteritis and Pregnancy[END_REF][START_REF] Aso | Clinical gynecologic features of pregnancy in Takayasu arteritis[END_REF]. Most of obstetric and maternal complications occurred during the second and third trimesters of pregnancy and are indeed due to TAK vasculitis damage, mainly hypertension. When TAK disease is known before the pregnancy and is inactive state with controlled hypertension, outcomes for the mother and new-born are usually good. When the disease is still active at pregnancy initiation and/or hypertension is uncontrolled, outcomes are more uncertain. Decisions about treatment and/or pregnancy continuation can be difficult. Inclusion of pregnant patients in cohort studies and protocol may be helpful to better identify patients with high risk of complications during pregnancy. Pregnancies in the setting of TAK should be considered high-risk, requiring close collaboration between obstetricians and rheumatologists/internists with experience in TAK disease and high-risk pregnancies.

Labour and delivery can be managed with epidural analgesia for the majority of patients [START_REF] Ioscovich | Peripartum anesthetic management of patients with Takayasu's arteritis: case series and review[END_REF][START_REF] Gautam | Successful low-dose spinal anaesthesia for lower segment caesarean section in a patient with Takayasu arteritis[END_REF][START_REF] Kassa | Successful spinal anaesthesia for caesarean section in an African patient with Takayasu's arteritis[END_REF][START_REF] Kuczkowski | Takayasu's arteritis in pregnancy and obstetric anesthesia[END_REF]. Regional anaesthesia can induce variations of blood pressure and should be used with caution during delivery. Increases in blood pressure can cause rupture of the aneurysms, aortic dissection and decreases in blood pressure can lead to cerebral ischemia [START_REF] Jayet | Management of a Thoracic Aortic Aneurysm during Pregnancy Leading to the Diagnosis of Takayasu Arteritis[END_REF][START_REF] Lakhi | Takayasu's arteritis in pregnancy complicated by peripartum aortic dissection[END_REF][START_REF] Mckay | Management of epidural anesthesia in a patient with Takayasu's disease[END_REF]. However, the control of blood pressure is not always easily achieved because of difficult brachial blood pressure measurements in TAK patients with pulseless upper extremities. The rate of caesarean deliveries in TAK patients is around 30%. Caesarean and operative vaginal deliveries are performed for obstetric indications. Low-dose spinal anaesthesia seems also safe for emergency caesarean section [START_REF] Gautam | Successful low-dose spinal anaesthesia for lower segment caesarean section in a patient with Takayasu arteritis[END_REF][START_REF] Dutta | Low-dose spinal anaesthesia for a parturient with Takayasu's arteritis undergoing emergency caesarean section[END_REF]. TAK disease itself, regardless of maternal complication, evolution during pregnancy and severity, should not be an indication for caesarean delivery.

Conclusion

Disease activity of TAK is frequently associated with a poor pregnancy outcome. More than 5% of pregnant women with TAK develop a life-threatening maternal cardiovascular complication. A good control of TAK disease activity and arterial hypertension before conception and during pregnancy is critical to improve both maternal and foetal outcomes.

Pregnancies in the setting of TAK should be considered high-risk, requiring a close collaboration between specialists involved in the care of TAK and obstetricians.