Women with systemic lupus erythematosus (SLE) face significant risks when embarking on a pregnancy, but attending a multidisciplinary clinic staffed by an experienced team can improve pregnancy outcome for women and their babies. Pregnancy in SLE should be planned and a management strategy should be agreed in full consultation with the patient, prior to conception. Pregnancy increases the likelihood of a lupus flare. It is not possible to predict when, or if, an individual patient will flare, although flare is more likely if disease has been active within 6 months of conception. Worsening of proteinuria in pregnancy could herald a lupus flare, but the differential diagnosis also includes the physiological response to pregnancy and pre-eclampsia. Corticosteroids, hydroxychloroquine and azathioprine are safe to use in pregnancy, with no adverse fetal effects reported despite many years of experience with their use. Correct identification of patients with antiphospholipid syndrome is important because treatment of affected women during pregnancy can improve fetal and maternal outcome. Neonatal SLE, although rare, carries a significant mortality and morbidity when the fetal heart is the targeted organ. Prophylaxis therapies, including treatment with intravenous immunoglobulin, await larger trials.