Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that affects 43.7 per 100,000 people worldwide, most commonly presenting in childbearing years. SLE pregnancies are complicated by cardiovascular events in up to 7.8% of cases, which translates to a 3.2- to 31.5-fold increase in severe maternal morbidity and a seven-fold increase in maternal mortality, compared to the general obstetric population. The highest risk is reported in cases with concurrent lupus nephritis or antiphospholipid syndrome [1]. These complications are not surprisingly seen; they are the end result of endothelial dysfunction, immune aberration, and placental dysfunction that precedes clinical decompensation by weeks [2,3].The current approach in management is reactive, while SLE needs proactive care. We suggest a structured three-phase approach to managing cardiovascular risk in pregnancy with SLE, from pre-conception through delivery and post-partum
