SLE primarily affects young females of childbearing age and fertility is generally conserved. SLE is a predominantly Th2-mediated disease and a progressive Th1/Th2 cytokine shift is seen in the fetal-maternal unit as well as in maternal circulation. Whether this fact affects pregnancy is unknown. Pregnancy represents a challenge for lupus patients and their physicians. However, the majority of SLE patients can now have successful pregnancies and deliver healthy babies, a result of our knowledge of the risks that SLE patients have to face during pregnancy, the preventive and therapeutic measures that we adopt, when necessary, and the close and appropriate rheumatological, obstetric and neonatal monitoring. All of these aspects are discussed in this review.