Approximately 30% of pregnant women are obese (body mass index [BMI] ≥ 30) and are at risk for adverse pregnancy outcomes. In this article, we review the literature on select obstetrical risks associated with maternal obesity and assess the recommended prevention and management strategies. The selected risks include infertility, fetal anomalies, gestational hypertensive diseases, gestational diabetes, intrauterine fetal death, cesarean birth, macrosomia, and long-term risks of adult disease for the fetus. The causes of these adverse outcomes include maternal body habitus, the proinflammatory state of obesity, and metabolic dysfunction. We also discuss how nurses, nurse practitioners, and nurse–midwives can make a difference in the prenatal care and immediate pregnancy outcomes of pregnant women with obesity and influence future health for these women and their children.