Systemic lupus erythematosus (SLE) is an autoimmune disease, involving multiple organs. It predominantly affects women of childbearing age in a ratio of 10:1 as compared to men [1] with no bearing on fertility but complicates pregnancy. Pregnant women with SLE are highly predisposed to complications like preeclampsia, preterm birth, exacerbation of disease, miscarriages, intrauterine growth restriction, and stillbirths. Active disease, prior lupus nephritis, presence of thrombocytopenia and antiphospholipid antibodies (aPLs) are the predictors of adverse pregnancy outcomes. Primigravida are at higher risk for pregnancy complications. Women desiring conception should be stabilized on drugs for at least 6 months [2]. However, currently, most patients of SLE have successful pregnancies due to preconception counseling, strict monitoring, and improved therapy with minimal complications for mother and fetus [3]. A multidisciplinary team approach, with close rheumatologist, obstetric, dermatologist, and nephrologist monitoring, is essential for optimal outcomes. This chapter will highlight major issues in SLE pregnancy and discuss the recent management strategies to minimize maternal and fetal risks.