Women with pulmonary hypertension have a high risk of morbidity and mortality during pregnancy. The inability of the heart to cope with the increase in the cardiac output and the physiological stress post-delivery often lead to heart failure and not uncommonly, death. The risks are compounded by the hypercoagulability, disruption of equilibrium in the pulmonary and systemic vascular resistance and interruption of pulmonary hypertension targeted therapy during pregnancy. While there are novel therapies for pulmonary hypertension, the risk of pregnancy in severe pulmonary hypertension is still prohibitively high. However, pregnancy is contraindicated in women with pulmonary hypertension. When pregnancy occurs, the care should be managed by a multidisciplinary team with experience in the management of both pulmonary hypertension and high-risk pregnancies. This talk focuses on the physiological changes seen in a parturient with severe pulmonary hypertension and some of the strategies employed by the team to mitigate pregnancy risks. Lastly, it reiterates the importance of pre-pregnancy counselling in managing this group of high-risk patients.