Relatively few data have been published on the management of pericardial diseases during pregnancy. Pericardial involvement is sporadic during pregnancy, and pregnant women do not show any specific predisposition to pericardial diseases. The more common form of pericardial involvement is hydropericardium, usually as a benign mild effusion recorded in about 40% of pregnant women by the third trimester, followed by pericarditis as the more common disease requiring medical therapy. The general management of these conditions is not different from those of nonpregnant women, although specific precautions should be followed for specific diagnostic and therapeutic issues during pregnancy. If possible, pregnancy should be planned in a phase of disease quiescence. Nonselective cyclooxygenase inhibitors and aspirin can be used safely during the first and second trimester, but should be withdrawn later and in any case at gestational week 32, because of the possible effects on ductus arteriosus and renal function. Low-medium doses of prednisone are allowed during all pregnancy and breastfeeding. Colchicine is generally contraindicated during pregnancy, except in women with familial Mediterranean fever. These pregnancies should be followed by a dedicated multidisciplinary teams.