SLE occurs in women of childbearing age and can cause multisystem and multiorgan damage. Because of the specificity of the population, the problem of fertility cannot be avoided. Due to the specificity of the disease and the risk of combined pregnancy, there are no authoritative guidelines for the diagnosis and treatment of these problems at home and abroad. 1. The basis of successful pregnancy The current level of treatment for SLE has been greatly improved, and the obstetric monitoring and treatment environment has been continuously improved, but it is still very important for SLE patients to have a stable condition before pregnancy. Unstable disease, especially the presence of LN and high titers of antiphospholipid antibodies, both increase the risk of maternal hypertension and preterm delivery [-4].Pregnancy outcome and timing in SLE patients are associated with a stable period from 4 to 6 months before conception. Under conditions of stable disease (at least 6 months, with medication regimen having been adjusted in advance), the frequency of pregnancy failure in SLE patients can approach that of normal pregnancy [4-6]. As far as the conditions of pregnancy are concerned, the criteria for judging stable disease in SLE should be (i) maintenance of a smaller hormonal dose (prednisone <15 mg/d) and no immunosuppressive drugs (e.g., cyclophosphamide, methotrexate, etc.) or at least 6 months of discontinuation; (ii) absence of clinical damage to vital organ systems such as the heart, lungs, kidneys, and central nervous system, and stable disease for 6 months to more than 1 year; (iii) stable renal function in those with LN [creatinine ≤ 140 μmol/L; normal blood pressure; urine protein quantification (24 h) ≤ 3 g]. If the above conditions are met, pregnancy can be planned [3-4]. Negative anti-dsDNA antibodies and normal complement C3 and C4 should not be used as mandatory indicators and should be assessed dynamically (some patients with long-term abnormal anti-dsDNA antibodies and complement C3 and C4, while other indicators are completely normal, may also plan a pregnancy) [4]. Contraception should be used for those who do not meet the target. Contraception should not be preferred to combination oral contraceptives, which can aggravate the disease and increase the risk of thrombosis [7]. SLE patients should have blood routine, urine routine, urine protein quantification (24h) (when urine protein is positive), blood biochemistry, Coomb's test, anti-cardiolipin antibody (ACL), lupus anticoagulant, anti-β2-glycoprotein Ⅰ (GPⅠ), anti-dsDNA antibody, anti-SSA antibody, anti-SSB antibody and complement C3 and C4 before pregnancy, which Pregnancy in SLE patients should be performed under the supervision of rheumatologists, obstetricians and gynecologists, and nephrologists [4, 8]. 2. Timing of pregnancy The timing of pregnancy is crucial for a successful pregnancy. In any case, physicians should prefer to proactively communicate with patients and families to emphasize the high-risk nature of pregnancy, pregnancy comorbidities and the possibility of pregnancy failure.SLE patients and healthy women have the same fertility, but SLE patients have fewer children than expected, which is mainly related to the lack of confidence in pregnancy and pregnancy miscarriage in SLE patients. Immunosuppressive drugs should be discontinued for more than 6 months in SLE patients who plan to become pregnant. Unplanned pregnancies while taking immunosuppressants also often bother doctors. This is because these drugs may cause stillbirths or neonatal malformations. Some unplanned pregnancies in patients taking immunosuppressive drugs (e.g., cyclophosphamide) can result in miscarriage and preterm delivery; however, there are also examples of normal deliveries of full-term fetuses with healthy newborns. Although there have been successful pregnancies and deliveries with immunosuppressive drugs, this drug has teratogenic effects and pregnancy with drugs (immunosuppressive drugs) is not yet encouraged [8-9]. The author believes that under current medical conditions, a more aggressive attitude should be taken towards the chances of pregnancy than before. For infertile SLE patients with stable disease and no SLE comorbidities, ovulation induction and in vitro fertilization can be attempted, and precedents of healthy fetuses born by in vitro fertilization in SLE patients are not uncommon. Patients who have had perinatal fetal loss also have a good chance of success in subsequent pregnancies [4, 6]. "Safe" medications should be continued throughout pregnancy. Low-dose aspirin and heparin should be used aggressively in the presence of positive antiphospholipid antibodies. Maintenance of hydroxychloroquine application has been shown to be safe, significantly reducing prednisone dosage, SLE progression, fetal loss rate, fetal growth restriction and fetal distress, and is safe during lactation [10-12]. In a large number of studies for the treatment of SLE, hydroxychloroquine was not found to be associated with an increased risk of congenital defects, spontaneous abortion, intrauterine death, preterm delivery, or a reduced number of live births, and also reduced the risk of maternal lupus cardiomyopathy. 3. Follow-up of pregnant patients is the key to success Patients with SLE have a higher risk of gestational hypertension, preeclampsia, and eclampsia than the healthy population. Poor pregnancy outcomes include miscarriage, preterm delivery, stillbirth, fetal growth restriction, intrauterine distress, and low birth mass infants. lN, infection, pulmonary embolism, and pulmonary hypertension may lead to fatal outcomes. Abrupt discontinuation of glucocorticoids causing adrenocortical failure is also frequently seen in pregnant patients [15-17]. When disease activity in pregnancy is present, prompt evaluation, decisive management, and immediate termination of pregnancy if necessary, should be performed. In nephrotic syndrome, full-term delivery is possible in those with normal or mildly impaired renal function, however, the expected delivery date should not be exceeded; if renal function continues to deteriorate, blood pressure is unsatisfactorily controlled, or fetal distress is present, the pregnancy should be terminated. Planned application of adrenocorticotropic hormones to promote fetal lung maturation prior to termination is beneficial in reducing the incidence of neonatal respiratory distress syndrome [2, 4]. Those with platelet counts < 20 x 109/L are at risk and require aggressive management; intravenous administration of immunoglobulin may be the preferred option. If the platelet count is < 50 x 109/L and there is a bleeding tendency, then cesarean section should also be performed to end the delivery. Patients at high risk for pre-eclampsia and thrombosis should be treated prophylactically with aspirin and heparin; treatment with plain heparin or low-molecular heparin combined with aspirin may reduce the rate of pregnancy loss. However, high doses of aspirin (> 3 g/d) lead to prolonged overdue pregnancies and deliveries, which also increase the complications of delivery bleeding. In addition, patients with SLE combined with pregnancy are prone to depression and targeted psychological interventions are necessary. After pregnancy, if disease activity occurs, those who were previously maintained on small doses of prednisone (5-15 mg orally daily) before pregnancy should be doubled to a maximum of 60 mg orally/d during pregnancy; in severe cases, methylprednisolone 60-100 mg daily, or shock therapy should be used. If the condition is severe during pregnancy and endangers maternal life, it should be combined with azathioprine, cyclophilin or cyclophosphamide after timely termination of pregnancy. Intravenous immunoglobulin infusion is a good choice for those with severe disease. The puerperium is a high-risk period for SLE patients with risk of thromboembolism, especially for antiphospholipid antibody-positive patients, who should be closely monitored for the first 4 d postpartum, especially in patients with recent disease activity or previous history of severe disease. Low relative molecular mass heparin should be used to prevent thrombosis until 4 to 6 weeks postpartum. Patients with a previous history of thrombosis may resume the amount of anticoagulant applied before delivery 2-3d postpartum. Calcium and vitamin D supplements are required for patients on long-term heparin use until the end of lactation.