Women with congenital heart disease (CHD) now comprise most patients with heart disease seen during pregnancy, accounting for 80% of all patients. In general, pregnancy is well tolerated in patients with CHD. For some women with particularly high-risk lesions and poor functional class, however, pregnancy poses significant risk for cardiovascular complications, including premature death. As result, preconception counseling and risk stratification are mandatory and should be done in all women of childbearing age with CHD.