Female obesity negatively impacts fertility and exposes women to adverse maternal and fetal outcomes during pregnancy. To reduce maternal and fetal risks, pregnancy in obese women should be planned and undertaken after weight loss, achieved through lifestyle changes, nutritional interventions, and, in more severe cases, evaluation of pharmacological or surgical options. The preconception process should begin at least six months before (two years for bariatric surgery) and include clinical and metabolic assessment, nutritional and obstetric counseling, and, if comorbidities (diabetes, hypertension, thyroid disease) are present, multidisciplinary management.