This chapter summarizes the clinical management of obesity in pregnancy, based on evidence where it exists, and highlights the areas where further research is needed. Obese women who are pregnant are recognized as a high-risk group by both the American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) and should therefore be referred for appropriate antenatal care. All obese women should receive a dietary assessment and nutritional counseling. Obstetric ultrasound is used widely in the developed world for pregnancy dating, detection of higher order pregnancies and fetal anomaly, and estimation of fetal growth. Obesity is a well-recognised risk factor for gestational diabetes mellitus, and pre-gestational diabetes is more prevalent in obese women. It has long been recognized that hypertensive disorders are more prevalent in the obese population. The anesthetist plays an important role in the care of the obese parturient.