Obesity during pregnancy: contemporary evidence and clinical implications

PURPOSE OF REVIEW: Obesity during pregnancy is a growing global health concern with implications for maternal, fetal, and intergenerational outcomes. This review highlights pathophysiological mechanisms, clinical risks, and evidence-based management strategies across the preconception, antenatal, and postpartum periods. RECENT FINDINGS: Maternal obesity amplifies pregnancy-associated insulin resistance, disrupts adipokine balance, and promotes inflammation, placental hormone dysregulation, and aberrant mTOR signaling. These mechanisms increase risks of gestational diabetes, hypertensive disorders, cesarean delivery, and macrosomia. Epigenetic modifications contribute to fetal metabolic programming, raising offspring risk of obesity, type 2 diabetes, and cardiovascular disease. Recent advances emphasize early risk stratification using continuous glucose monitoring, lipid and inflammatory biomarkers, and integration of telehealth-based lifestyle interventions. Precision medicine and microbiome-targeted therapies represent emerging frontiers. SUMMARY: Management of obesity in pregnancy requires a continuum of care. Preconception optimization through lifestyle interventions and, in select cases, bariatric surgery improves outcomes. Antenatal care demands individualized metabolic monitoring, adherence to gestational weight gain targets, and pharmacologic interventions such as metformin when indicated. Postpartum priorities include structured weight management, diabetes prevention, and lactation support. Multidisciplinary, culturally tailored strategies are essential to mitigate the global burden of maternal obesity and its intergenerational consequences.