Maternal obesity is one of the major challenges in obstetric care, with its prevalence continuing to increase worldwide. Obesity during pregnancy is associated with an increased risk of several complications, particularly gestational diabetes mellitus, gestational hypertension, preeclampsia, and cesarean delivery. It is also associated with fetal and neonatal complications, including macrosomia, large-for-gestational-age infants, certain congenital anomalies, and increased admission to the neonatal intensive care unit. Management of obesity during pregnancy requires an integrated approach that begins before conception and includes appropriate gestational weight gain, improved nutrition and physical activity, and close monitoring of maternal and fetal health. Evidence suggests that regular physical activity may help reduce the risk of gestational diabetes and fetal macrosomia. Early intervention during pregnancy may also help reduce the intergenerational transmission of obesity-related metabolic disorders. Therefore, evidence-based standardized guidelines are needed to improve the care of pregnant women with obesity and reduce short- and long-term complications. The increasing prevalence of obesity among women of reproductive age has become an important health concern, making maternal obesity a common condition in modern obstetric practice. Obesity is associated with an increased risk of adverse maternal and fetal outcomes, with risks generally increasing with the severity of obesity. Several mechanisms contribute to these complications, including insulin resistance, chronic low-grade inflammation, and metabolic and hormonal changes that may affect placental function and fetal growth. Some fetal growth abnormalities may also occur in women with obesity without evident glucose intolerance. Maternal and Fetal Complications of Obesity : Maternal obesity is associated with an increased risk of gestational diabetes, gestational hypertension, preeclampsia, cesarean delivery, as well as certain infectious and thrombotic complications and anesthesia-related difficulties. The need for intensive care may also increase in cases of severe obesity. For the fetus and newborn, macrosomia and large-for-gestational-age status are among the most important complications associated with maternal obesity. There may also be increased risks of low Apgar scores, admission to the neonatal intensive care unit, stillbirth, miscarriage, and certain congenital anomalies, including neural tube and cardiac defects. These effects are not solely related to elevated blood glucose levels, as disturbances in lipid and insulin metabolism and other metabolic factors may also contribute to excessive fetal growth. Management of Obesity and Gestational Weight Gain : Gestational weight gain in women with obesity should be limited and appropriate to their individual health status. Some studies suggest that more restrictive weight-gain targets may help reduce complications such as hypertension, cesarean delivery, and fetal macrosomia. Recommendations for gestational weight gain should consider the degree of obesity, overall health status, and population characteristics rather than applying a single recommendation to all women. Lifestyle Interventions : Balanced nutrition and physical activity are among the most important non-pharmacological strategies for managing obesity during pregnancy. Counseling on weight management and healthy lifestyle practices is ideally initiated before conception. Regular physical activity improves metabolic health and may reduce the risk of gestational diabetes and fetal macrosomia, particularly when adherence is good. Modern technologies, including wearable devices and remote monitoring, may also support physical activity tracking and improve adherence to healthy lifestyle interventions.Monitoring and Multidisciplinary Care : Women with obesity require close monitoring during pregnancy to facilitate early detection of gestational diabetes, hypertensive disorders, and fetal growth abnormalities. Multidisciplinary care involving obstetricians, endocrinologists, dietitians, and physiotherapists may improve the management of these cases. Weight-loss medications, including glucagon-like peptide-1 (GLP-1) receptor agonists, are not recommended for intentional use during pregnancy. Their safety during the preconception period also requires further research. Long-Term Effects : The effects of maternal obesity extend beyond pregnancy. Maternal obesity may increase the risk of postpartum weight retention, future type 2 diabetes, cardiovascular disease, and other metabolic disorders. Maternal obesity may also affect the child’s long-term health. The concept of fetal programming suggests that the intrauterine environment can influence the child’s future health, potentially increasing the risk of obesity, insulin resistance, type 2 diabetes, hypertension, and cardiovascular disease later in life. Evidence suggests that physical activity during pregnancy may improve the metabolic health of both mother and child and may help reduce the intergenerational transmission of obesity-related metabolic disorders. Conclusion : Maternal obesity represents an increasing challenge in obstetric care and is associated with higher risks of gestational diabetes, hypertensive disorders, cesarean delivery, macrosomia, and several fetal and neonatal complications. Its effects may also extend into the long term, affecting the health of both mother and child. Early intervention beginning before conception, together with appropriate weight management, healthy nutrition, regular physical activity, close medical monitoring, and multidisciplinary care, is essential. Evidence-based and population-appropriate guidelines are also needed to improve maternal and fetal outcomes and reduce the future burden of obesity-related diseases. Ali Rasool Hussein. Al Mustaqbal University The First University in Iraq