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Objectives Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predominantly affects women of reproductive age, presenting a unique challenge during pregnancy. Pregnancy further complicates the course of the disease in patients with SLE, and on the other hand, the disease affects pregnancy outcomes. The aim of this retrospective study was to analyze pregnancy outcomes in women with SLE treated at the University Hospital Split (UH Split).Methods This retrospective cohort study included 15 pregnant female patients diagnosed with SLE based on the revised ACR classification criteria. Patient data were collected from medical records at the Department of Rheumatology and Clinical Immunology, UH Split. Parameters included autoantibody profiles, complement levels and pregnancy outcomes. Statistical analysis was performed using descriptive methodsResults After SLE diagnosis, 28 pregnancies were recorded in 15 pregnant patients with significant rates of adverse outcomes: 9 stillbirths, 6 miscarriages, 1 case of neonatal death, and 50% preterm birth rate. Median birth weight among preterm infants was 1620 g. Cesarean section was the most frequent mode of delivery. ANA was positive in 93.33% of patients, anti-dsDNA in 53,3% and anti-Ro antibodies in 40% of patients.Conclusions This study confirms that SLE represents a significant risk for pregnancy outcomes. Improving pregnancy outcomes requires pregnancy planning, treatment optimization, disease control, and a multidisciplinary approach.