BACKGROUND: Pregnancy in women with SLE is considered high risk, particularly in the presence of active disease, organ damage or lupus anticoagulant (LA). Improvements in SLE and obstetric management may have enhanced outcomes. METHODS: We compared pregnancies from the prospective GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares) cohort with those from the French general population using perinatal survey (Enquêtes Nationales Périnatales (ENP)) data. Eligible pregnancies resulted in a birth ≥22 weeks of gestation (WG) or ≥500 g, in accordance with the ENP inclusion criteria. Each GR2 pregnancy was matched with four ENP pregnancies based on maternal age, parity, number of fetuses and region. Live birth rates were evaluated after excluding minors, anonymous births and refusals. Adverse pregnancy outcomes (APOs) were assessed among live births with complete medical records and were defined as placental insufficiency-related preterm birth, severe small-for-gestational-age infant (birth weight <3rd percentile) or neonatal death. RESULTS: We matched 430 GR2 pregnancies to 1720 ENP pregnancies. At inclusion, 336/397 (84.6%) women had no clinical lupus activity, 327/385 (84.9%) had no organ damage, 68/428 (15.9%) were LA-positive and 417/430 (97.0%) received hydroxychloroquine. Live births occurred in 423/430 (98.4%) GR2 pregnancies versus 1667/1720 (97.0%) ENP pregnancies (OR=1.49 (0.64 to 3.45); p=0.14). APOs occurred in 75/406 (18.5%) SLE pregnancies versus 134/1629 (8.2%) ENP pregnancies (OR=2.53 (1.86 to 3.44); p<0.001). APOs remained higher in GR2 pregnancies without disease activity, organ damage or LA positivity (30/209; 14.4%) than in ENP pregnancies (p<0.01). Univariate analysis identified SLE, nulliparity, smoking, chronic hypertension, twin pregnancy and fertility treatment as APO-associated factors. In multivariate analysis, SLE remained independently associated with APOs (aOR=2.91 (2.06 to 4.09); p<0.001). CONCLUSION: Among pregnancies progressing beyond 22 WG (or birth weight ≥500 g), live birth rates were comparable to those in the general population, but APOs were more than two times as frequent in women with SLE. TRIAL REGISTRATION NUMBER: NCT02450396.