Introduction: Cardiovascular diseases in pregnant women are challenging, with high maternal and perinatal morbidity and mortality, so a cardio-obstetric team is recommended for their care.Even so, little data evaluates the impact of these teams.Therefore, the present study aims to compare the obstetric, maternal, and neonatal outcomes of semi-structured follow-up (SSF) in a Cardio-obstetric clinic concerning regular or unstructured follow-up (USF) in pregnant women with heart disease.Methods: A prospective registry of pregnant women with heart disease was carried out.Patients with SSF by a cardio-obstetric team were compared with those with single evaluation or USF.The risk of events was calculated according to the modified World Health Organization (mWHO) classification and the CARPREG-II scale, and cardiac, obstetric, and neonatal outcomes were evaluated.Results: One hundred sixty-eight patients were evaluated, 37 with SSF and 131 with single evaluation (USF).The primary diagnoses were congenital heart disease, arrhythmias, and valve disease.The average CAR-PREG-II in USF patients was 2.48 (SD 2.3); in SSF patients, it was 3.37 (SD 2.45; p = 0.041).The average of the mWHO in patients with USF was 2.1 (SD 1.6), and with SSF, it was 2.65 (SD 0.95; p = 0.0052).There were no significant differences in primary cardiac outcomes (13.8% in USF vs. 5.4% in SSF; p = 0.134), secondary cardiac (5.3% in USF vs. 2.7% in SSF; p = 0.410), obstetric (10% in USF vs. 16.2% in SSF; p = 0.253) and neonatal (35.9% in USF and 40.5% in SSF; p = 0.486) even though patients with SSF had a higher risk than patients with USF according to the mWHO and CARPREG-II scales.Conclusions: In pregnant women with heart disease, an SSF compared with a USF by a cardio-obstetric team did not show statistically significant differences in cardiovascular, obstetric, and neonatal outcomes.However, patients with SSF had a significantly higher risk of adverse outcomes due to the mWHO and CARPREG-II scales.This result suggests that the SSF achieves at least equal outcomes despite the higher risk of adverse events that patients in this group had.