Background: Heart disease is the important cause of maternal morbidity and mortality during the antepartum and postpartum period. The prevalence of heart disease during pregnancy varies from 0.3 to 3.5% (2). We aimed to know the spectrum of heart disease in pregnancy and its impact on the maternal and fetal outcome. Methodology: The study was conducted in the Department of Obstetrics and Gynecology of the tertiary care referral Centre of Western Rajasthan, India. Data from November 2019 to October 2021 were collected from the labour room and obstetric ward records. Results:Forty-eight pregnant women were diagnosed with heart disease over a period of two years. The prevalence of heart disease in pregnancy was 1.3%. Rheumatic heart disease was the main cardiac lesion (85.42%), with mitral stenosis being the most commonly seen (31.25%). Previous cardiac surgery was found in 14.58% of patients. Half of women gave birth by spontaneous vaginal delivery (50%), 43.75% of subjects by cesarean section and 6.25% of participants underwent instrumental delivery. Admissions to intensive care unit (ICU) were noted in 16.67% of cases, and those to neonatal intensive care unit (NICU) in nine newborns (18.75%). There were only two maternal deaths and no baby born with congenital heart disease. Conclusion:Heart disease in pregnancy is a high-risk condition and significantly impacts the mother and fetal outcome. By proper antenatal, intrapartum and postnatal supervision under a multidisciplinary team, maternal and fetal mortality and morbidity can be reduced.