Introduction: Heart disease complicating pregnancy is a leading cause of maternal morbidity and mortality in Sri Lanka. Understanding the pattern and outcomes of heart disease complicating pregnancy will help to optimise the care.Objective: Describe maternal and fetal outcomes of heart disease complicating pregnancy in a tertiary care unit from 2013 to 2017.To compare the pattern of heart disease complicating pregnancy over the years from the same unit to assess whether there is a change in the pattern of cases presenting in pregnancy.To study the reasons for termination of pregnancy in patients with cardiac disease during the study period Method: Retrospective analysis of secondary data collected from clinical notes of pregnancies complicated with heart disease.Results: A total of 248 cases with diagnosis of cardiac disease complicating pregnancy were included in the study.15 patients had termination of pregnancy in the first trimester due to severe heart disease. Two hundred thirty three (233) patients continued the pregnancy until the delivery. Out of these 233, heart disease was diagnosed during the index pregnancy in 18.9% (n-44) of the patients. Heart disease was categorised as acquired (47.2%), congenital (28.2%), mitral valve prolapse (15%), cardiac arrhythmias (9.4%). Among acquired heart disease 89% was rheumatic in origin. Mitral valve (89.7%) was the commonest valve affected amongst women with rheumatic carditis (n=98). Cardiac decompensation at delivery occurred in 7.7%. Pulmonary hypertension was present in 22.9% with acquired heart disease and 31.7% with congenital heart disease. Three intra uterine fetal demise and two maternal deaths occurred during this period. Conclusion:Rheumatic heart disease remains the commonest heart disease in pregnant women in Sri Lanka. There is an increase proportion of women with congenital heart disease. A significant number required therapeutic termination which highlights the need for improved pre-pregnancy preparation.