Background: Pregnancy adaptations are well tolerated in healthy women but it rapidly decompensate in pregnants with valvular heart disease resulting in maternal and perinatal morbidity2 . Multidisciplinary approach and proper guideline is a necessity to reduce the adverse outcome. Aims and Objectives: Clinical and echocardiographic assessment of valvular heart disease during pregnancy, in south Indian population and its effect on maternal and fetal outcome. Thereby provide local layout of disease burden and help develop patient centric management plan. Materials and Methods: 77 pregnant women admitted with valvular heart disease in Coimbatore Medical College Hospital were recruited during period of 2020-2021. Clinical and Echocardiographic correlation with Maternal and fetal outcome were studied. Results: In our study, 70.1% of pregnants had Rheumatic heart disease and 23.4% had Congenital heart disease, with ratio of 3:1; 70.3% were diagnosed during index pregnancy. Mitral valve was the most common valve involved (84.4%) with Mitral Regurgitation being the predominant lesion (62.3%); Aortic valve involvement (14.3%); Both Aortic and Mitral valve involvement (3.9%). Functional class deterioration were seen in pregnants with critical stenotic lesions and severe insufficiency. Increase in valvular gradient in stenotic lesions is associated with congestive failure. Maternal outcome: 63.6% had caesarean section; 31.7% had cardiac indications; 7.8% had instrumental delivery; 1 maternal death; 23.4% had Congestive Cardiac Failure. Fetal outcome: 71% had term delivery; 28.6% had preterm delivery; 11(14.3%) had fetal loss; 48% low birth weight; 5.2% Intrauterine growth retardation; Perinatal mortality was 7.5% in NYHA class I, II and 42.1% in class III, IV. Conclusion: High transvalvular gradient, Depressed LV function and increased LV volume, especially in patients with stenotic lesion is associated with life threatening complications in the course of pregnancy. Regurgitant lesion have better tolerability and outcome as compared to obstructive lesion. There was close association of NYHA class and maternal and fetal outcome, with higher risk in NYHA class III and IV.