Lead readily crosses the placenta by passive diffusion. Cord blood lead levels are strongly correlated to maternal blood lead levels, with cord BLL being, on average, 0.80 times that of maternal BLL. Prenatal and early childhood lead exposure are associated with decreased IQ, learning and behavior problems, and reduced growth. Elevated maternal BLLs are associated with an increased risk for gestational hypertension, spontaneous abortion, and preterm delivery. The most critical step in clinical management is identifying and eliminating any ongoing exposure source. Potential exposure sources may differ in pregnant women compared to young children. Examples of possible sources include hobbies, workplace exposures, pregnancy-related pica, lead paint dust from renovations, traditional medicines, and endogenous bone lead stores from past exposures. During pregnancy, the mobilization of bone lead increases as the bone is resorbed to produce the fetal skeleton. Because of this, an elevation in BLL may occur without any recent or ongoing exposures. Based on the maternal BLL, medical management may include nutrition counseling, calcium supplementation, referral to services, and additional testing. Pregnant women with BLLs ≥45 μg/dL should be treated as a high-risk pregnancy with consultation from an expert in lead poisoning and chelation. Clinicians should also provide a referral to a maternal-fetal medicine specialist.