In the past two decades the diagnosis of systemic lupus erythematosus (SLE) has become easier to make and more certain when made. Advances in treatment have permitted patients with SLE to live longer and healthier lives. New clinical research has also described the role that some autoantibodies associated with SLE have on fetal well-being. As a result, many women with SLE or SLE-like disease now attempt pregnancy, and obstetricians, perinatologists, and pediatricians now consider the diagnosis of SLE when pregnancy complications occur to apparently healthy women. There has been a growth in our knowledge and a change in our understanding of lupus pregnancies. These new data form the basis of this review.