A retrospective analysis of 120 pregnant women with systemic lupus erythematosus (SLE) identified first pregnancy as a risk factor for flare of disease activity during pregnancy. The investigators identified 47 episodes of flare (relapse rate 37.9%), the most common manifestations of which were renal, joint, cutaneous and haematological. Flare of disease activity during pregnancy was associated with increased frequency of pre-eclampsia and preterm delivery. Primigravida was associated with an increased risk of any type of SLE flare during pregnancy (OR 2.3, 95% CI 0.99–5.52, P = 0.05), whereas the main risk factors for renal flare included primigravida (OR 3.6, 95% CI 1.19–11.3, P = 0.02) as well as disease activity prior to pregnancy (OR 3.7, 95% CI 0.97–14.1, P = 0.05), and previous renal disease (OR 5.8, 95% CI 1.95–17.6, P = 0.001).