• antiphospholipid syndrome
• pregnancy
• systemic lupus erythematosus
• undifferentiated connective tissue disease

Systemic autoimmune diseases (SAD) frequently affect women of child-bearing age, and for these patients pregnancy are considered at high risk of maternal and fetal complications, especially in cases of systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).
Our studies were aimed at describing the course of pregnancy and at identifying predictors of adverse pregnancy outcomes both in terms of obstetric complications and disease flare in patients with undifferentiated connective tissue disease (UCTD), SLE, APS and Sjӧgren syndrome (SS).
Pregnancy outcome was significantly better in patients with well controlled disease at the beginning of pregnancy, in particular in cases of disease remission. On the contrary, a residual disease activity at conception (both clinical and serological), might impact on pregnancy outcomes.
We have also observed an increased risk of complications in cases of severe organ involvement such as in cases of history of lupus nephritis.
In our cohort the second trimester uterine artery Doppler seems to have a good predictive role of adverse pregnancy outcome, while the levels of free β-human chorionic gonadotrophin (hCG) and pregnancy-associated plasma protein A (PAPP-A) detected during first trimester do not seem to be useful to identify patients with SAD at higher risk of complications.
A strength of our studies is that they reflect the real-world setting in referral centre for pregnancy care in patients with SAD, and therefore the results of the studies are generalisable to day-to-day practice.
Our studies also underline the importance of prenatal planning and closely monitoring during pregnancy and puerperium by an expert multidisciplinary team to ensure a more favourable pregnancy outcome.
In conclusion, despite the progress in diagnosis and treatment, pregnancy in patients with SAD are still at risk of maternal and fetal complications also in cases of well controlled disease activity, and further studies are necessary to increase the knowledge on predictors on pregnancy outcome in order to plan further actions aimed at improving the care provided to SAD patients during all the phases around pregnancy planning.