Systemic lupus erythematosus has a predilection for women of childbearing age and may potentially complicate pregnancy. Poor pregnancy outcome in women with systemic lupus erythematosus has been principally ascribed to the presence of renal involvement. Maternal risks have been more difficult to evaluate because of the unpredictable nature of the disease and limited individual experience. The present study reports the outcome of 108 pregnancies in 39 women affected by systemic lupus erythematosus with and without renal manifestation of the disease. Prematurity, small-for-gestational-age birth weight, stillbirth, and spontaneous abortion occurred more frequently in women after the diagnosis of systemic lupus erythematosus was made. Those women with renal involvement had an even further increase in spontaneous abortions as well as a decrease in successful pregnancy outcome (P less than .05). Morbidity in this group of women was rare in the immediate postpartum period, but increased morbidity and mortality did occur in the first two years after delivery.