Cardiovascular disease (CVD) is a leading cause of maternal morbidity and mortality, affecting 1–4% of pregnancies worldwide, with hypertensive disorders and congenital heart disease as the most prevalent etiologies. Rising maternal age, improved survival of women with congenital heart defects into reproductive years, and persistence of rheumatic heart disease in low- and middle-income regions contribute to an increasing burden. Pregnancy induces profound hemodynamic, hematologic, and hormonal adaptations, including a 40–50% increase in cardiac output, reduced systemic vascular resistance, relative anemia, and hypercoagulability, which may unmask or exacerbate underlying CVD. This chapter reviews the epidemiology, pathophysiology, risk stratification, and multidisciplinary management of CVD in pregnancy. Key domains include pre-pregnancy counseling, genetic assessment, and the use of the modified WHO classification to predict maternal and fetal risk. Diagnostic strategies—such as echocardiography, electrocardiography, and judicious use of imaging modalities—are discussed alongside considerations for timing and mode of delivery. Disease-specific management is outlined for acyanotic and cyanotic congenital heart diseases, valvular lesions, prosthetic valves, cardiomyopathies, coronary artery disease, pulmonary hypertension, Marfan syndrome, and arrhythmias. Special emphasis is placed on anticoagulation strategies in mechanical valve recipients, the teratogenic risk of cardiovascular drugs, and the management of hypertensive disorders. The chapter underscores the critical role of multidisciplinary “pregnancy heart teams” in optimizing maternal and neonatal outcomes through individualized care planning and vigilant peripartum monitoring.