Obesity is reaching pandemic proportions worldwide. It is increasingly being recognised as a risk factor during pregnancy. Women should ideally be counselled preconceptionally about the increased risks and encouraged to lose weight actively, some may be candidates for bariatric surgery. Maternal risks include gestational diabetes, hypertension and pre-eclampsia, increased incidence of operative delivery, postpartum haemorrhage, anaesthetic risks as well as infective and thrombo-embolic complications while fetal risks include miscarriage, neural-tube defects, macrosomia and stillbirth. Obstetric units should institute appropriate guidelines for the management of pregnancy in this 'high-risk' group of women.