Hypoparathyroidism during pregnancy requires careful review and follow-up to avoid maternal and fetal complications including fetal losses. Pregnancy is associated with physiologic changes in the calcium-regulating hormones which include a rise in calcitriol levels, with increased calcium absorption from the bowel, as well as an increase in the renal calcium filtered load. Parathyroid hormone related peptide (PTHrP) production is increased, and the source is both the placenta and the breasts. There is variation in the response to these physiologic changes during pregnancy, and women require close monitoring to ensure that serum calcium is maintained in the low-normal reference range. Calcium supplements are safe in pregnancy, as is the use of calcitriol and cholecalciferol. The safety of PTH has not been evaluated during pregnancy. The use of hydrochlorothiazide is not recommended during pregnancy. Close monitoring by a multidisciplinary team including primary care, endocrinologist, pediatrician, and obstetrician is necessary for optimal outcomes for both the mother and the baby.