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Objectives Women with systemic autoimmune connective tissue diseases remain at increased risk of adverse pregnancy outcomes despite advances in multidisciplinary care. We aimed to examine pregnancy outcomes in women with systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), and antiphospholipid syndrome (APS) followed at two tertiary care centers in Denmark during 2021–2023, and to compare findings with national pregnancy outcome data.Methods We conducted a retrospective cohort study including all pregnancies among women aged >18 years with SLE, MCTD, or APS followed at two Danish tertiary centers (Aarhus and Copenhagen) between 2021 and 2023. These centers provide specialized care for women with systemic autoimmune connective tissue diseases across four of five Danish regions, representing approximately 70% of the national population. Cases were identified using ICD-10 codes for SLE, MCTD, or APS combined with obstetric codes for pregnancy, birth, or abortion. Clinical data were extracted from medical records. National data on pregnancy outcomes served as reference.Results We identified 131 pregnancies in 110 women (SLE 72%, MCTD 11%, APS 17%). Median (and mean) maternal age at conception was 32 years (mean age in the general population: 31.5 years).Preconception counselling was most frequently documented in the SLE group (85%) and least frequently in the APS group (68%).Live births occurred in 79% (SLE 79%, MCTD 93%, APS 73%), and 70% reached term (>37 weeks). Stillbirths occurred in 2% (all SLE), and early spontaneous abortions (<10 weeks) were most frequent in APS (27%). Median birth weight was 3,177 g. Two major congenital malformations were recorded, with no cases of congenital heart block or neonatal lupus.Maternal complications included preeclampsia/eclampsia (6%), HELLP (3%), gestational hypertension (13%), and gestational diabetes (3%). Compared with national data (live births 99%, term 94%, stillbirth 0.4%, preeclampsia/eclampsia 4%), adverse outcomes were substantially more common across all groups.Abstract PO:08:207 Table 1–2Conclusions Pregnancies in women with SLE, MCTD, and APS remain high-risk, with increased rates of fetal loss and maternal complications compared with the general population. Our findings underscore the ongoing need for structured preconception counselling, individualized risk assessment, and coordinated multidisciplinary management, to optimize maternal and fetal outcomes.