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OBJECTIVES: To evaluate the maternal and fetal outcome of pregnancies complicated by cardiac disease in a developing country. METHODS: A prospective analysis was carried out of 40 pregnancies in women with cardiac disease who delivered at 28 weeks of gestation and beyond from June 2009 to May 2010 at a tertiary care center in the eastern part of India. RESULTS: Rheumatic heart disease (n=28, 70%) with isolated mitral stenosis (n=21) was the predominant cardiac problem. Septal defects were the most common form of congenital heart disease (n=10). In 28 (13.52%) women, the diagnosis of cardiac disease was made during pregnancy. Patients in NYHA class I/II (n=29, 72.5%) had fewer maternal complications and their babies had a higher birth weight than those in NYHA class III/IV (n=11, 27.5%). Cardiac complications were noted in 27 (67.5%) patients. Commonest complication developing during pregnancy, labor and puerperium was congestive cardiac failure (n=14, 35%). Maternal mortality was noted in 3 patients (7.5%), 2 of which were due to cardiac failure and pulmonary edema. Six patients (15%) delivered preterm and thirteen patients (32.5%) had low birth weight babies. There were three neonatal deaths and one stillborn. CONCLUSIONS: Rheumatic heart disease was the predominant type. Patients in NYHA class I/II had a better maternal and fetal outcome than those in NYHA class III/IV. Surgically treated women tolerate pregnancy well. Vaginal delivery was safer and caesarean section should be reserved only for obstetric indications. Maternal and perinatal outcome can be improved by team approach at tertiary care center.