Purpose of Review <p>We present current and published findings relevant to the placental role in fetal congenital heart disease (CHD) pregnancies, specifically those affected by common maternal comorbidities including diabetes, obesity, and preeclampsia. We review findings of adaptative and pathophysiological changes in the placenta and discuss how they may influence fetal and neonatal development and outcomes in the context of congenital heart disease.</p> Recent Findings <p>Common maternal comorbidities including diabetes, obesity, and preeclampsia influence placental development in fetal CHD. Placental findings in these pregnancies include both maternal and fetal vascular malperfusion lesions, variations in villous maturation, inflammation, oxidative stress, and decreased placental function including impaired oxygen and nutrient delivery.</p> Summary <p>The placenta likely plays an influential role in the altered intrauterine environment associated with diabetes, obesity, or preeclampsia, contributing to fetal CHD pathogenesis and sequelae. Exact mechanisms and impact on short- and long-term outcomes warrant further investigation.</p>