Nephrolithiasis during pregnancy poses a distinct clinical challenge due to the complex interactions between the physiological changes of pregnancy and the restrictions on diagnostic and treatment options. While relatively rare, nephrolithiasis ranks as a significant cause of non-obstetric hospital admissions in pregnant women and can lead to major maternal and fetal complications if not managed properly. Pregnancy-induced anatomical and hormonal changes, such as urinary stasis, hypercalciuria, and ureteral dilation, increase the risk of stone formation. Diagnosis is often complicated by overlapping obstetric symptoms and limited imaging options due to concerns about fetal radiation exposure. This chapter examines the pathophysiology, epidemiology, and clinical presentation of nephrolithiasis in pregnancy, focusing on safe diagnostic methods such as ultrasonography, magnetic resonance imaging, and minimal use of low-dose computed tomography. Though management is mainly conservative, surgical options like ureteroscopy or percutaneous drainage may be considered in cases that are refractory or complicated. A multidisciplinary approach that integrates obstetric and urological expertise is crucial for ensuring timely intervention, minimizing risks, and optimizing outcomes for both the mother and fetus.