Project 462095

With recent advances in lupus treatment, the vast majority of affected women can now consider pregnancy. However, pregnant women with lupus still face an unacceptably high risk of maternal and fetal complications. Therefore, the overarching aim of our proposal is to better understand predictors of disease flare and adverse pregnancy outcomes in pregnant women with lupus to optimize counselling and personalize management. We aim ultimately to improve the health outcomes for women with lupus and their offspring. More specifically, using an international prospective cohort of unselected lupus pregnancies, the "Lupus prEGnAnCY (LEGACY)" cohort, we will address the following 3 main objectives: 1. Evaluate if women with lupus achieving a low disease activity state in the first trimester have a reduced risk of disease flare and adverse outcomes during pregnancy compared to those who do not achieve the low disease activity state. 2. Assess if a new antibody (which promotes clotting) increases the risk of pregnancy complications in lupus pregnancies. 3. Determine if women with low blood levels of certain medications in the first trimester have an increased risk of disease flare and adverse outcomes during pregnancy compared to those with appropriate blood levels. The LEGACY cohort is set to become the world's largest prospective cohort investigating pregnancy in unselected SLE patients. Our research will lead to a novel and much-needed approach for risk assessment and personalized therapy in pregnant women with lupus. Ultimately, our efforts will help improve the reproductive health of this vulnerable population.