Rheumatological conditions are generally more common in women and affected individuals of reproductive age are of relevance to obstetricians. While they form a heterogeneous spectrum on conditions, they are associated with an increased maternal and perinatal morbidity and mortality risks, particularly in active disease. Adverse outcomes include possible worsening of the condition during pregnancy and flares which pose diagnostic challenges, as well as early and late pregnancy losses, fetal growth restriction, congenital heart block and heart failure, superimposed pre-eclampsia and preterm birth. These are complex high risk pregnancies and should be managed in a joint multidisciplinary clinic with the rheumatologist, neonatologist and anaesthetist overseeing fetal, maternal, obstetric and neonatal concerns. Pre-Pregnancy counselling, preparation and contraception are often inadequately addressed in clinical practice. Besides disease assessment, a review of the drugs is important before commencing and during pregnancy. Often patients will stop medications on misplaced fears of causing pregnancy harm. Education, counselling and support, emphasising the importance of treatment compliance maintaining disease control and acquiescence as a key criteria towards successful pregnancy outcomes. Specific obstetric issues pertaining to SLE and scleroderma will be discussed.