Lung cancer during pregnancy is exceptionally rare, with only 93 reported cases from 1953 to 2024. Our study identified 40 cases of lung cancer during pregnancy from a 9 million patient database, contributing to a total to 133 documented instances in the literature, and the only powered case series. Using the HCUP-NIS database (2004-2014), we conducted a retrospective analysis comparing maternal and fetal outcomes in women with and without lung cancer. Results showed that pregnant women with lung cancer were older and had higher rates of smoking, chronic hypertension, and pregestational diabetes (P<0.01, all). Significant risks included placenta previa (OR: 5.67, 95% CI:1.36-23.65, p=0.017), abruptio placenta (OR: 4.99, 95% CI: 1.49-16.74, p=0.009), operative vaginal delivery (OR: 4.88, 95% CI: 2.14-11.11, p<0.001), and transfusion (OR: 8.92, 95% CI: 3.28-24.28, p<0.001). They also have markedly higher odds of venous thromboembolism (OR:21.83, 95% CI: 2.92-163.47, p<0.001), disseminated intravascular coagulation (OR:  8.45, 95% CI: 1.14-62.42, p=0.04), and maternal death (OR: 195.02, 95% CI: 40.61-936.55, p<0.001), highlighting the necessity for specialized care and further research into this rare and complex condition.