Cardiovascular imaging during pregnancy poses a unique challenge to clinicians in differentiating between physiological changes mimicking pathology and true pathologic conditions, as well as for radiologists in terms of image quality. This review article will focus on 3 goals: first, to familiarize radiologists with safety issues related to imaging pregnant women using computed tomography and magnetic resonance imaging; second, to review the current, evidence-based recommendations for radiology topics unique and common to pregnant and lactating patients; and third, to provide practical algorithms to minimize risk and increase safety for both the pregnant woman and the fetus.