Maternal risk may also be classified by lesions [6] (Table 4). Severe systemic ventricular impairment,
previous peripartum cardiomyopathy with residual ventricular impairment, severe left heart
obstruction, pulmonary arterial hypertension (PAH) of any cause and Marfan syndrome or other
aortopathy with aorta >40 mm are associated with a significant risk of mortality, and women with
these conditions should be advised that pregnancy would be associated with a high risk of morbidity
and mortality. Any treatment to reduce pregnancy risk should be considered, and effective contraception
should also be discussed as well as alternatives to pregnancy.