Pregnancy, Reproduction, and Sexual Health Recommendations for Pregnancy Referenced studies that support recommendations are summarized in Online Data Supplement 19. COR LOE Recommendations I C-LD Women with CHD should receive prepregnancy counseling with input from an ACHD cardiologist to determine maternal cardiac, obstetrical and fetal risks, and potential long-term risks to the I C-LD An individualized plan of care that addresses expectations and contingencies should be developed for and with women with CHD who are pregnant or who may become pregnant and shared with the patient and all I B-NR Women with CHD receiving chronic anticoagulation should be counseled, ideally before conception, on the risks and benefits of specific anticoagulants during I B-NR Women with ACHD AP classification IB- D, IIA-D, and IIIA-D* should be managed collaboratively during pregnancy by ACHD cardiologists, obstetricians, and anesthesiologists experienced in I C-EO In collaboration with an ACHD cardiologist to ensure accurate assessment of pregnancy risk, patients at high risk of maternal morbidity or mortality, including women with pulmonary arterial hypertension (PAH), Eisenmenger syndrome, severe systemic ventricular dysfunction, severe left-sided obstructive lesions, and/or ACHD AP classification ID, IID, IIID* should be counseled against becoming pregnant or be given the option of terminating pregnancy. I B-NR Men and women of childbearing age with CHD should be counseled on the risk of CHD recurrence in offspring.S3.13.1-9 IIa B-NR Exercise testing can be useful for risk assessment in women with ACHD AP classification IC-D, IIA-D, and IIIA-D* who are considering pregnancy.S3.13.1-10,S3.13.1-11 IIa B-NR When either parent has CHD, it is reasonable to perform fetal *See Tables 3 and 4 for the ACHD AP classification system. 