In conclusion, women with Marfan syndrome without previous cardiac complications seem to tolerate pregnancy well, up to an aortic root diameter of 45 mm, with good clinical care before, during, and after pregnancy. Pregnancy should be discouraged in women with previous aortic dissection because of the high risk for aortic complications. Pregnancy causes a slight increase in aortic root diameter. In the long run women with enlarged aortic root diameters at pregnancy, show a slightly accelerated aortic root growth and therefore will have elective aortic root surgery at a younger age. In all women, especially with enlarged aortic root diameters, the pros and cons of pregnancy should be fully discussed as well as the alternatives (childlessness, adoption, and surrogate pregnancy).