Obese women of childbearing age are increasing every year. Obese pregnant women are at risk and need to pay more attention to perinatal care and pregnancy nutrition, exercise, and monitoring in order to achieve good pregnancy outcomes. Pregnancy itself is a state of insulin resistance, and obese pregnant women are at increased risk for many poor pregnancy outcomes. Pre-pregnancy obesity and overweight are associated with poor pregnancy outcomes, including hypertension, diabetes, respiratory (asthma, sleep apnea), thromboembolism, increased rates of surgical cesarean delivery, susceptibility to incisional infections, endometritis, anesthesia complications (difficult intubation or epidural placement), and congenital malformations of the newborn, fetuses larger than gestational age, stillbirth, obstructed shoulder birth, and distant adult complications (obesity, diabetes). Risk of complications in obese pregnant women: (1) 2 to 3 times increased risk of anovulatory infertility in women of childbearing age. (2) 1.5 to 2 times increased risk of miscarriage during early pregnancy. (3) Thromboembolism: Pregnant women with a body mass index ≥30 have a 2-fold increased risk of thrombosis and a 5-fold increased risk of deep vein thrombosis. (4) Hypertensive disease: the risk of hypertension in pregnancy increases 2 to 3 times in pregnant women with a body mass index ≥ 30, and they are also prone to hypertension and heart disease in the distant future. (5) The risk of stillbirth stillbirth increases by 2 to 3 times. (6) The risk of preterm birth increases by 1.5 to 2 times. (7) The risk of surgical delivery increases by 2 to 3 times. (8) The risk of birth defects increases 2 to 3 times. (9) 1.5 to 2 times increased risk of fetal overgrowth and giant babies. (10) The risk of gestational diabetes increases 3 to 5 times with excessive weight gain during pregnancy. (11) Because of the thick subcutaneous fat in obese women, this can lead to ultrasound difficulties, poor image quality and easy to miss birth defects. (12) There is also an increased risk of many cardiovascular diseases in the distant future. Obese pregnant women cannot use surgery or drugs to lose weight during pregnancy, but can only use preventive measures to avoid excessive weight gain. Special attention should be paid to dietary safety during pregnancy, healthy and nutritious eating, increased physical activity, and timely lifestyle assessment and monitoring of both mother and baby to improve pregnancy outcomes.