BACKGROUND: Idiopathic osteonecrosis of the hip is a serious complication of pregnancy, but there is little information available regarding its recurrence in a subsequent gestation. CASE: A woman with a history of pregnancy-related osteonecrosis, successfully treated with conservative therapy, presented for preconceptual counseling. Because a literature search uncovered only one applicable case, the patient was managed empirically. Her subsequent pregnancy was uneventful with no recurrence. CONCLUSION: Although idiopathic osteonecrosis of the hip during pregnancy is uncommon, it is important to establish the outcome in subsequent pregnancies. Avoidance of vigorous physical activity, measures to limit edema, and low-dose aspirin therapy were successful in this patient.