Pregnancy, labor, delivery, and the puerperium cause many changes in the urinary and genital tracts. The management of lower urinary tract symptoms, disease, and genital prolapse during and after pregnancy is controversial. Patients treated surgically for incontinence, genital prolapse, and lower urinary tract reconstruction present a challenge to the obstetrician and other doctors caring for them during pregnancy. This article reviews the literature on the effect of pregnancy, labor, delivery, and the puerperium on lower urinary and genital tract disease. Preventive methods to reduce subsequent pelvic floor muscle damage and urinary and fecal incontinence are reviewed. The management of pregnant women with antecedent urinary and genital tract abnormalities also are summarized.