Heart disease is the joint most common cause of maternal death in the UK. 1 The most common cardiac causes of death involve cardiomyopathy and pulmonary hypertension (fig 1). Congenital heart disease (CHD) is infrequently associated with maternal death, but forms the greatest workload in a cardiac antenatal clinic and may be associated with significant maternal morbidity. The population of adults with CHD is growing rapidly both in numbers and complexity of disease. There were an estimated 133 000 adults with CHD in the UK in 2000, 10 000 with complex disease; the population is expected to grow to 166 000 by 2010 with a 50% increase in those with complex conditions. Half this population are women, the majority of whom are well enough to contemplate pregnancy; this can either be seen as a major problem, or as an indication of the successes of congenital cardiac surgery and cardiology. Preventing maternal death must be the prime aim of all cardiologists involved in the care of pregnant women. However, many women with heart disease can have a successful pregnancy; it is important that their doctors are educated so that they are not inappropriately advised against pregnancy. Conversely, patients for whom pregnancy carries an unacceptable risk (table 1) must be correctly counselled and given contraceptive advice. A detailed review of contraception in heart disease is beyond the scope of this article.