Introduction <p>Pregnancies in women with chronic medical conditions are characterized by a higher maternal and perinatal complication rate during pregnancy, childbirth, and the postpartum period. The German Maternity Guideline does not provide specific recommendations for the care of these women. The aim of this study was to evaluate the care of pregnant women with pre-existing medical conditions in German perinatal centers (Level 1 and 2) and perinatal care level 3 hospitals.</p> Materials and methods <p>Based on guidelines and literature, seven topics were identified: preconception counseling, timing of consultation, care for pregnant women with rare diseases, participation in continuing education, multidisciplinary case conferences, resources for patient counseling, and transfer of the patient to another center. Representatives of all perinatal centers were contacted by email and invited to participate. The anonymous online survey was conducted using the SoSci Survey platform.</p> Results <p>Of 310 centers, 103 (33.2%) representatives responded. 62.2% (<i>n</i> = 64) reported managing 11–30 pregnant women with pre-existing conditions per month. 22.1% (<i>n</i> = 23) of all centers regularly care for pregnant women with rare diseases, and 46.6% offer preconception counseling. University hospitals offer these services more frequently. Regular case conferences are held in 34.0% of centers, and 80.6% of medical staff regularly participate in continuing education on the topic.</p> Conclusion <p>According to the results of our survey, 76.7% (<i>n</i> = 79) of perinatal centers regularly care for patients with pre-existing conditions, while only 22.1% care for patients with rare diseases. The findings highlight the need to implement standardized recommendations and targeted resource allocation to ensure optimal care for this patient group.</p>