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Objectives To compare pregnancy outcomes in women with SLE with those of the French general population, and to identify factors associated with adverse pregnancy outcomes (APOs).Methods We compared pregnancies from the prospective GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares) study with those from the French general population using perinatal survey (ENP) data. Eligible pregnancies resulted in a birth at 22 weeks of gestation (WG) or later, and/or with a birth weight of 500 g or more. Each GR2 pregnancy was matched with four ENP pregnancies based on maternal age, parity, number of fetuses, and region. Adverse pregnancy outcomes (APOs) were defined as a composite of preterm birth occurring before 37 WG related to placental insufficiency, small-for-gestational-age newborns, and/or neonatal death .Results Among 430 eligible GR2 pregnancies (mean maternal age 31.7 ± 3.6 years), 336/397 (84.6%) had no clinical activity and 327/385 (84.9%) no chronic organ damage at inclusion. Lupus anticoagulant was present in 68/428 (15.9%). Treatments included hydroxychloroquine in 417/430 (97.0%), corticosteroids in 194/426 (45.5%), low-dose aspirin in 371/419 (86.3%) and low-molecular-weight heparin in 164/429 (38.2%). The 430 GR2 pregnancies were initially matched to 1,720 ENP pregnancies. Live birth occurred in 423/430 (98.4%) GR2 versus 1,667/1,720 (97.0%) ENP pregnancies (p = 0.14). After exclusion of ENP pregnancies without live birth or with incomplete records, 423 GR2 live births were matched to 1,692 ENP pregnancies. APOs occurred in 75/406 (18.5%) GR2 versus 134/1,629 (8.2%) ENP pregnancies (p < 0.001) . Pooling GR2 and ENP live births, univariable analysis showed associations between APOs and SLE (75/209, 35.9% vs 331/1,826, 18.1%), nulliparity (157/209, 75.1% vs 1,090/1,826, 59.7%), active smoking (49/195, 25.1% vs 285/1,733, 16.4%), chronic hypertension (9/208, 4.3% vs 26/1,818, 1.4%), twin pregnancy (56/209, 26.8% vs 78/1,826, 4.2%) and fertility treatments (38/197, 19.3% vs 163/1,737, 9.4%) (all p < 0.01). Multivariable analysis confirmed SLE (aOR 2.99 [2.11–4.24]), nulliparity (aOR 2.01 [1.41–2.92]), active smoking (aOR 2.27 [1.55–3.30]) and twin pregnancy (aOR 8.11 [5.20–12.62]) as independent predictors of APOs.Abstract LBA:01:26 Table 1Maternal and neonatal in GR2 and matched ENP pregnancles ending in live birthsConclusions Live birth rates were comparable to those in the general population, but APOs were more than twice as frequent in women with SLE.