There is no consensus on the management of systemic lupus erythematosus (SLE), much less pregnancy in SLE patients. However, several key issues in the management of SLE in pregnancy are commonly faced by rheumatologists, nephrologists, and obstetricians. These include the treatment of SLE activity in pregnancy, the ascertainment of lupus nephritis, treatment of antiphospholipid antibodies, treatment of hypertension, and laboratory monitoring. These key issues will be examined in this chapter.