Pregnancy for patients with antiphospholipid syndrome (APS) and lupus has historically been associated with complications, including increased risk for preeclampsia, fetal growth restriction, and fetal death, but outcomes have improved in the last 2 decades. However, identifying, predicting, and preventing the risk for pregnancy complications in this population still remains challenging. Taking us on a deep dive into the subject is the 2020 recipient of the Rheumatology Research Foundation Shaun Ruddy Memorial Lectureship, Jane Salmon, MD, the Collette Kean Research Chair at the Hospital for Special Surgery and professor of medicine and obstetrics and gynecology at Weill Cornell Medicine, New York.