All providers who care for reproductive-aged women with cardiac disease should assess these patients' desires and plans for pregnancy at every encounter. For those considering pregnancy, preconception counseling, often performed by a maternal-fetal medicine specialist, can help patients understand the potential implications of pregnancy on their health and estimate the risks of an adverse cardiac event prior to conceiving. There are cardiac conditions, such as pulmonary hypertension and aortic stenosis, in which pregnancy may be contraindicated given the high morbidity and mortality; there are tools available to help quantify a patient's risk. Furthermore, some cardiac lesions may be inherited, which may warrant parental testing or a discussion of strategies to reduce the risk of an affected child, such as the use of assisted reproductive technologies. Preconception counseling is also important to identify other maternal risk factors, such as obesity, hypertension, and tobacco use, which are associated with adverse pregnancy outcomes and develop a strategy to mitigate their potential risks, ideally before pregnancy. For women on medications for their heart disease or other comorbidities, a thorough review of these medications can potentially avoid an exposure to a teratogen during conception and pregnancy. Once pregnant, a patient's obstetrical provider and cardiologist should work together to outline a plan to monitor a patient's cardiac status as the normal physiologic changes of pregnancy, such as increased blood volume and cardiac output, may challenge a patient's functional status and increase the risk for an adverse outcome. Labor and delivery planning are essential to ensure patients with cardiac disease deliver at the appropriate hospital, equipped with the staff and resources to care for women with complex conditions. In summary, preconception counseling aims to stratify a patient's risk in pregnancy, inform patients of possible complications, and discuss strategies to best ensure a healthy mother and baby during pregnancy, labor, and delivery.