The objective of this work was to analyse the course of maternal disease and fetal outcome in pregnant patients with systemic lupus erythematosus (SLE) counselled and followed according to a protocol intended to optimize maternal and fetal outcome. The prospective study included all pregnancies between 1987 and 1993 in SLE patients known at least 6 months before pregnancy at the Lupus Clinic of our hospital. In 25 patients there were 35 pregnancies. Thirty-four (97%) started at sustained remission of disease; 11 (31%) were in women with antiphospholipid antibodies (aPL); 14 (40%) in women with a history of biopsy-proven lupus nephritis; one (3% in a woman with a serum creatinine above 125 mumol/l. In 29 pregnancies (82%) maternal disease remained inactive during gestation. In three pregnancies (9%) active disease was treated with prednisone. There were no serious post-partum flares of disease. Pregnancy resulted in 25 (71%) live births, 8 (23%) first trimester abortions, and one intrauterine fetal death. One pregnancy was terminated because of hydrocephalus. Nine of 25 (36%) live births were delivered by caesarean section. For 6 of 9 (67%) caesarean sections the indication was fetal distress and pre-eclampsia. In the majority of patients with SLE who conceive at remission, the disease does not flare in pregnancy. With optimal obstetric care, close follow-up and treatment with low-dose aspirin if aPL are present, a high success rate (71%) can be achieved.