Objective: To determine the prevalence of pre-eclampsia and fetal growth restriction (FGR; <3rd centile) in women with pre-existing cardiac dysfunction. Design: Retrospective cohort study. Setting: Maternity units in UK and Australia. Population: Pregnant women with impaired left ventricular ejection fraction<55%. Methods: Routine clinical data, including medical history and pregnancy outcome were collected retrospectively. Main Outcome Measures: Pre-specified outcomes included pre-eclampsia and FGR prevalence in women with pre-existing cardiac impairment, compared with the general population; and the relationship between pregnancy outcome and pre-pregnancy cardiac phenotype. Results: In this cohort of 282 pregnancies, pre-eclampsia prevalence was not significantly increased (4.6% [95% C.I 2.2-7.0%] versus population prevalence of 4.6% [95% C.I. 2.7-8.2], p=0.99); 12/13 of these women had additional obstetric/medical risk factors. However, prevalences of preterm pre-eclampsia (<37 weeks) and FGR were increased (1.8% versus 0.7%, p=0.03; 15.2% versus 5.5%, p<0.001, respectively). Neither systolic nor diastolic function correlated with pregnancy outcome; however, left ventricular mass index (LVMi) weakly correlated with pre-eclampsia (5g/m2 increase: OR 1.18 [95% C.I. 1.01-1.38], p=0.04). Antenatal ß blockers (n=116) were associated with lower birthweight Z score (adjusted difference -0.33 [95% C.I. -0.63- -0.02], p=0.04). Conclusions: This study demonstrated a modest increase in preterm pre-eclampsia and significant increase in FGR in women with cardiac dysfunction. These results do not support a causal relationship between cardiac dysfunction and pre-eclampsia, especially accounting for the background risk status of the population. The mechanism underpinning the relationship between cardiac dysfunction and FGR merits further research but could be influenced by concomitant ß blocker use.