Expecting a baby can be an exciting journey, but when you’re living with obesity — a medical condition defined by a body mass index (BMI) of 30 or higher — the path may have a few more twists and turns. The good news is that knowing about these potential challenges can help you and your healthcare team create the best plan for you and your baby.

Just how does obesity affect pregnancy? Here are seven important risks to keep in mind, along with tips on how to manage them.

1. Blood Sugar Concerns

Some people develop gestational diabetes, a temporary condition in which your body has trouble managing blood sugar during pregnancy. Having obesity raises this risk.

High blood sugar during pregnancy can cause macrosomia — when your baby grows larger than normal. This can make delivery harder and increase the chances of needing a cesarean section (C-section), which is surgery to deliver the baby. Gestational diabetes may raise your baby’s risk of developing type 2 diabetes and obesity later in life, as well as make you more likely to develop type 2 diabetes.

Your doctor will likely test for this condition early in your pregnancy. They may suggest you follow a healthy diet, get regular exercise, and check your blood sugar levels. Some people may also need medication. Early testing and regular prenatal care are key to keeping you and your baby healthy.

2. Blood Pressure Challenges

Preeclampsia, a serious condition that causes a sudden spike in blood pressure, can lead to liver and kidney failure and other serious complications. Preeclampsia usually occurs after 20 weeks of pregnancy or soon after giving birth.

Preeclampsia is more common in individuals with obesity. To protect the health of you and your baby, you may need to deliver your baby earlier than planned.

Watch for warning signs such as unusual swelling, headaches that won’t go away, or changes in your vision, and be sure to report them to your doctor right away. Regular blood pressure checks and urine tests at prenatal visits can help catch preeclampsia early.

3. Obstructive Sleep Apnea

Do you snore loudly or do you wake up feeling tired, even after a full night’s sleep? You might have sleep apnea, a condition in which breathing repeatedly stops and starts during sleep. Obesity raises the risk of sleep apnea, which can cause poor sleep and low oxygen levels, and pregnancy can make this condition worse.

Poor sleep can contribute to fatigue, high blood pressure, and heart problems during pregnancy. If you snore heavily or feel tired during the day, talk to your doctor. They may recommend doing a sleep study or getting a special machine to help you breathe better at night.

4. Delivery Complications

Labor and delivery can be more complicated and take longer if you’re living with obesity. There’s also a higher chance of needing a C-section, which can come with risks like infections and longer recoveries.

Obesity can make it harder to monitor the baby during labor or give anesthesia (pain-numbing medication). Your healthcare team may need to take special steps to keep you and your baby safe.

Talk with your doctor about your birth plan. If a C-section is needed, your care team will work to lower the risks. Eating well and staying active during pregnancy can also help prepare your body for delivery.

5. Preterm Birth, Miscarriage, and Stillbirth

Babies born to people with obesity are more likely to arrive early — before 37 weeks — which is called preterm birth. Conditions such as preeclampsia and gestational diabetes can raise the risk of early delivery or other pregnancy complications.

There’s also a higher risk of pregnancy loss. This includes miscarriage (loss before 20 weeks) and stillbirth (loss after 20 weeks). According to the American College of Obstetricians and Gynecologists (ACOG), the risk of a stillbirth increases as BMI increases.

Regular prenatal care is the best way to catch problems early. Your doctor may recommend extra or earlier tests to help monitor your baby’s growth and keep both of you safe.

6. Birth Defects

Birth defects — problems with how a baby’s body develops — can affect the heart, brain, spine, or other organs. Babies born to people with obesity have a higher risk of birth defects, especially heart problems and neural tube defects, which affect the brain, spinal cord, or spine.

Taking folic acid supplements before and during pregnancy may help lower the risk of some birth defects. Talk with your doctor about the right amount for you. They may also suggest extra ultrasounds or tests to keep track of your baby’s development.

7. Health Risks for the Baby Later in Life

Your pregnancy health affects your baby beyond birth. Children born to people with obesity are more likely to develop childhood obesity, asthma, and other health conditions, either at birth (called congenital conditions) or later in life.

Healthy habits during pregnancy, like eating nutritious foods and getting regular physical activity, can help give your baby a healthy start. Breastfeeding, if you’re able, may also help lower your child’s risk of obesity.

How To Manage These Risks

The most important step you can take is to talk with your healthcare provider. Together, you can make a plan that fits your needs and keeps you and your baby healthy. Here are some additional tips:

Start Prenatal Care Early

The sooner you begin prenatal care, the better. If you’re already pregnant, make an appointment as soon as possible. If you’re planning to get pregnant — or you have trouble conceiving or notice a lower sex drive — talk with your doctor ahead of time. Regular appointments help monitor your health and your baby’s health throughout pregnancy.

Ask About Specialized Care

Some clinics offer dedicated support and special care for people with higher BMIs. This care may include additional screenings or help from other healthcare professionals, such as registered dietitians.

Eat a Balanced Diet

Focus on getting a variety of colorful fruits and vegetables, whole grains, and lean proteins. Cut back on foods and drinks that are high in sugar or fat. Even small, healthy changes can make a difference.

Stay Active

Movement can boost your mood, improve sleep, and help prepare your body for labor — it’s not just good for weight management. Gentle activities like walking, swimming, and prenatal yoga can be safe and helpful. Always check with your doctor about physical activities that are safe for you.

Take Your Vitamins

Prenatal vitamins, especially those containing folic acid and iron, support your baby’s development and your health. Talk to your doctor about which medications and vitamin-and-mineral supplements you should be taking.

Track Your Progress

Ask your doctor how much gestational weight gain is healthy for you. According to Mayo Clinic, the recommended amount is 11 to 20 pounds during pregnancy with one baby and 25 to 42 pounds when carrying twins. However, everyone’s body is different, and your healthcare provider may suggest a goal for you.

With the right care and support, many people with obesity have safe, healthy pregnancies. By understanding your risks and then working with your doctor to manage them, you can give your baby the best possible start in life.

You deserve respectful, high-quality care. Don’t be afraid to ask questions, speak up about your concerns, and find a healthcare provider who supports you every step of the way.

Talk With Others Who Understand

MyObesityTeam is the social network for people with obesity and their loved ones. On MyObesityTeam, members come together to ask questions, give advice, and share their stories with others who understand life with obesity.

Are you currently pregnant or planning a pregnancy? What steps have you taken to reduce any pregnancy risks? Share your experience in the comments below, or start a conversation by posting on your Activities page.