Background: Heart disease in pregnancy is a leading cause of non-obstetric maternal and neonatal morbidity. Physiological changes during gestation can exacerbate existing cardiac conditions. A multidisciplinary approach involving obstetricians, cardiologists, and anesthesiologists is essential for managing these patients from preconception through the postpartum period. Therefore, the aim of the current study is to evaluate the impact of heart disease on maternal and fetal pregnancy outcomes. Methods: This prospective, cross-sectional study was conducted at Baghdad Teaching Hospital from May 2023 to May 2024, involving 81 pregnant women with heart disease. Baseline data, maternal complications (cardiac and obstetrical), and fetal outcomes were recorded. Results: Valvular heart disease, particularly mitral valve disease, was predominant. Most patients had mild disease severity. Maternal outcomes showed increased rates of congestive heart failure and arrhythmia. Fetal outcomes revealed higher incidences of preterm delivery and low birth weight. Conclusion: Pregnant women with heart disease face high risks for both maternal and fetal complications, with outcomes closely related to the type and severity of the cardiac condition.