**1. Introduction**

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease characterized by production of autoantibodies and polymorphic manifestations of end-organ damage [1, 2]. The disease can manifest itself in many forms and severity, ranging from mild cutaneous and joint involvement, to devastating ocular complications or lethal renal, cardiac and cerebral involvement [3]. SLE is caused by interactions between susceptibility genes and environmental factors, resulting in irreversible loss of immunologic self-tolerance. Its estimated incidence ranges from 0.3 to 23.2 per 100.000 person-years and it mostly affects women, with a female to male ratio as high as 10–15:1 [4, 5]. In women, prevalence varies between 164 to 406/100.000 [6] and most of them are in childbearing age. For these reasons, reproductive health and family planning are issues of utmost importance for physicians managing SLE patients, including internists, rheumatologists, and gynecologists. Even if fertility is not impaired in SLE, pregnancy represents a high-risk period in the disease course, mainly due to serious potential maternal and fetal complications. On the maternal side, risk of flare is increased during pregnancy, and there is risk of pre-eclampsia (PE) and thrombotic complications, especially in women carrying antiphospholipid antibodies (aPL). On the fetal side, fetal growth restriction (FGR) and preterm birth are feared complications, besides the potential harm caused by maternal antibodies, as it is the case of congenital heart block (CHB) and neonatal lupus in women carrying SS-A and SS-B antibodies. Multidisciplinary approach, preconception counseling, pregnancy planning and increased availability of safe drugs in pregnancy and puerperium have contributed to improve both maternal and fetal outcomes.
