Heart disease is a major cause of mortality and morbidity in pregnant women. It is reported in 0.2 to 4% of all pregnancies. The incidence of heart disease in pregnancy has increased in the last two decades due to better surgical treatment for congenital heart disease, due to which more number of women are surviving to reach adulthood and opting to conceive and continue pregnancy. Pregnancy is associated with major physiological adaptations in to ensure adequate blood supply to uterus and to ensure blood supply to growing fetus. The net result is increase in cardiac output, plasma volume, heart rate and decrease in systemic vascular resistance. Risk assessment in pregnancy is based on CARPREG scoring system. Patient should be informed about the increased chance of miscarriage, prematurity and fetal growth restriction. If pregnant female is on warfarin it needs to be switched to heparin at pregnancy detection and again at 36 weeks. In general, vaginal delivery is preferred and delivery should occur in tertiary centres with readily available team of cardiologist, anesthetist, senior obstetrician and neonatologist.