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(BJOG. 2015;122(11):1446–1455)An increased incidence of adverse outcomes (maternal mortality, miscarriage, thromboembolism, and obstetric hemorrhage) has been reported among pregnant women with prosthetic heart valves. Infants born to these women are also at increased risk of perinatal mortality, preterm birth, small-for-gestational-age, and congenital malformations. There have been advances in prosthetic heart valve design and medical care, leading to improved outcomes for patients with prosthetic valves. Review of the available data on recent outcomes in parturients with prosthetic heart valves is therefore required. The primary objective of this systematic review was to assess the risk of an adverse outcome in pregnant women with prosthetic heart valve(s) over the last 20 years (1995 to 2014). Absolute risk of adverse outcomes by prosthetic type and/or location was also evaluated as a secondary objective.