Pregnancy places a significant burden on the cardiovascular system and may lead to heart failure, arrhythmias, and, rarely, maternal mortality in women with pre-existent heart disease. The objective of this review was to provide an overview of maternal and fetal outcomes and complications of pregnancy in women with hypertrophic cardiomyopathy (HCM). A systematic review of the literature in the MEDLINE database was performed to identify cohort design studies reporting outcome and complications of pregnancy in HCM. The literature search returned 11 studies on 9 patient cohorts reporting the outcome and complications of pregnancy in HCM. In case of >1 publication on a particular cohort, the most recent publication was included in the analysis. A pooled analysis of the outcome data was performed, and weighted event rates and 95% confidence intervals were calculated. The analysis of data from 9 cohorts, including 237 women and 408 pregnancies, demonstrated that most pregnancies in women with HCM are uneventful. Still, pregnancy in women with HCM carries maternal and fetal risks. The maternal mortality rate was 0.5%, and any complication or worsening of symptoms occurred in 29% of the patients. Fetal mortality was caused by spontaneous abortion (15%), therapeutic abortion (5%), and stillbirth (2%). Premature birth was observed in 26%. In conclusion, maternal mortality related to pregnancy in women with HCM is low and appears to be confined to women with a high-risk profile before pregnancy. Fetal mortality is comparable to that in the general population; however, the risk of premature birth is increased.