Pericarditis in women who are pregnant or of childbearing age poses a challenge to clinicians. At present, there are no guidelines regarding the optimal approach for managing pericarditis in pregnancy regarding selecting the appropriate method of diagnostic imaging or tailoring the treatment regimen to gestational age. Pericarditis in pregnancy may manifest as an autoimmune or autoinflammatory phenotype but the predominant etiology is idiopathic. Transthoracic echocardiography and cardiac magnetic resonance are considered safe, but data are lacking on the use of gadolinium-based contrast agents. Shared decision-making is paramount to balance the risks and benefits of radiation and contrast exposure to the mother and fetus. The safety profile of treatment options differs at each time interval from preconception to the 3 trimesters and postpartum phase. A multidisciplinary approach using imaging guidance can improve outcomes in pregnant patients with pericarditis. Further studies are needed to ascertain the safety of interleukin-1 blocking agents in pregnancy.