Background: The 20-30% of women with antiphospholipid syndrome (APS) remains unable to give birth to healthy neonates despite the conventional treatment. The purpose of this review is to summarize literature on the predictors of poor pregnancy outcome in women affected by APS. Results: History of pregnancy morbidity and/or thrombosis and the association with SLE are well known historybased predictive factors for pregnancy failure in women with APS. Moreover, laboratory findings associated with unsuccessful pregnancy outcome are lupus anticoagulant positivity, triple antiphospholipid antibodies (aPL) positivity, false-positive IgM for CMV and hypocomplementemia. The abnormal uterine arteries Doppler velocimetry results are confirmed to be strongly associated with poor maternal and feto-neonatal outcomes in APS pregnancies. Conclusion: To correctly explore and identify these clinical and laboratory variables associated with pregnancy failure is a critical step in aiding clinicians to manage and counsel the women with APS. Finding the optimal combination therapy according to these risk factors to prevent the main maternal and feto-neonatal complications in APS pregnancies is warranted.