In the past 30 years, the number of patients with adult congenital heart disease (ACHD) has progressively exceeded the number of children with CHD.1 At present, more than 1.4 million individuals in the United States are living with ACHD. Many are women of childbearing age. Patients with ACHD are surviving to old age as the result of better surgical techniques and medical management. Care in specialized ACHD centers has been demonstrated to reduce mortality among these patients.2 They often have reasonably good functional capacity and hope to participate in the activities of their similarly aged peers, including childbearing.