Abstract: Obesity (body-mass index ≥ 30 kg/m²) now affects more than 20 % of pregnant women worldwide and is a major driver of adverse obstetric and long-term cardiometabolic outcomes. Because weight loss during gestation is generally discouraged, the window for intervention spans pre-conception optimisation, tailored antenatal surveillance, risk-adapted intrapartum planning, and structured post-partum care. This narrative review synthesises guidelines and primary research published 2020-2025 to outline best-practice management of women with obesity in pregnancy. Core themes are: (1) pre-pregnancy counselling, folic-acid optimisation and bariatric-surgery timing; (2) early first-trimester booking with baseline metabolic assessment; (3) lifestyle, nutritional and pharmacologic strategies that safely limit gestational weight gain to Institute of Medicine (IOM) targets; (4) prevention, screening and treatment of obesity-related complications such as gestational diabetes, hypertensive disorders and venous thrombo-embolism; (5) anaesthetic, operative and neonatal considerations; and (6) post-partum weight-management, lactation support and inter-pregnancy interval planning. Evidence shows that multicomponent lifestyle programmes reduce excessive weight gain by 20-30 % and confer modest improvements in glycaemic control, while higher-dose thromboprophylaxis and ultrasound-guided neuraxial analgesia mitigate intrapartum morbidity. Remaining research gaps include precision nutrition, pharmacotherapy trials and long-term maternal-child cardiometabolic surveillance.