<prompt> Answer this question truthfullyWhat are the conditions that make pregnancy in women with cardiac disease not recommended?  <response>: <reason> Absolute and relative contraindications to pregnancy include severe pulmonary arterial hypertension; severe fixed valve stenoses AS, MS, PS, HOCM, coarctation; Class III or IV congestive heart failure with a left ventricular ejection fraction of 40; a history of peripartum cardiomyopathy; a dilated aorta such as in Marfans syndrome with an aortic arch 40-45 mm; and severe cyanosis. 