Cardiac medi- cations may need to be adjusted during pregnancy and counseling provided to discuss the options for and potential impact of those changes. Some specific com- plications may be more common in women with cer- tain types of CHD, such as hypertension, which is more common in women with coarctation.S3.13.1-22,S3.13.1-23 The offspring of patients with ACHD have an increased risk of CHD and other events such as prematurity.S3.13.1-24 All women with CHD should receive appropriate counsel- ing regarding contraception choices. A multidisciplinary team that includes ACHD specialists and maternal-fe- tal medicine obstetricians with expertise in caring for women with heart disease is appropriate for achieving optimal outcomes. Recommendation-Specific Supportive Text 1. Prepregnancy counseling allows for an individu- alized risk assessment. This will include discuss- ing maternal risks for pregnancy, delivery, and postpartum period, and medications that may be teratogenic and require alternative therapies (eg, angiotensin-converting enzyme inhibitors/ angiotensin-receptor blockers). Additionally, counseling should include a discussion related to fetal risk in regard to CHD transmission and overall risk to the health of the fetus. ACHD car- diologists are valuable in accurately assessing pregnancy risks. Risk may be overestimated or underestimated by providers without expertise in CHD and pregnancy, leading to patients re- ceiving inaccurate recommendations on risks of pregnancy, risks of delivery, and the type of de- livery (eg, the incorrect notion that most women with CHD require cesarean delivery for cardiac reasons). 2. This care plan should address maternal cardiac risks on the basis of the individual patient s anatomy and physiology. Clear documenta- tion is important so that all providers are well aware of the risks and expected outcomes, in- cluding risk of maternal volume shifts, arrhyth- mias, labor and delivery plan, and need for maternal cardiac monitoring when indicated. 