Pregnancy in pulmonary hypertension (PH) is associated with a high maternal morbidity and mortality. The normal physiologic pulmonary and systemic hemodynamic alterations that occur during pregnancy are poorly tolerated during pregnancy, birth, and the immediate postpartum period. This article (a) highlights the normal anatomic and physiologic changes that accompany pregnancy and the potential deleterious consequences on the cardiopulmonary circulation in pregnant PH patients and (b) provides an in-depth approach in the management of the pregnant PH patient.