Cardiac disease is the leading cause of maternal mortality in the world. The majority of women with heart disease are able to tolerate pregnancy. However, for some women with severely impaired heart functions like ventricular disfunction, pulmonary hypertension, severe left heart obstruction, and aortopathy, such as Marfan syndrome, with significant aortic dilatation, pregnancy is associated with a significant risk and these women should be counselled against pregnancy if there is no option for treatment that reduces risk. It is crucial that caring for those pregnant women are aware of the risk factors for and presentation of cardiac conditions in pregnancy.