More women with complex congenital heart disease are now surviving into childbearing age. Most of these women have residual hemodynamic lesions that may impair cardiovascularadaptation to pregnancy related physiologic changes. The second and third trimesters of pregnancyare associated with significant increase in preload, and heart rate with slight decrease in afterload. Labor is associated with abrupt increase in cardiac output mostly due to increase in heart rate and contractility in the first stage and increase in preload in the second stage of labor. These physiologic changes are tolerated differently based on the type and complexity of cardiac lesions. Antenatal cardiovascular assessment is necessary to determine lesion-specific risk for the mother and the fetus. Multi-disciplinary approach is required at all stages of pregnancy in patients with significant risk of cardiovascular complications.