In 2025, the World Obesity Atlas reported that more than 1.5 million pregnant women in the United States had obesity. Data from the Centers for Disease Control and Prevention (CDC) reveal significant disparities across racial and socioeconomic lines. By race, Black, Latinx, and Native American women have the highest rates of obesity, while white and Asian women have the lowest. By income, women with a college education and those who can afford health care out of pocket have the lowest instances of maternal obesity.
Women who have had four or more children face higher rates of obesity, a trend tied to disparities in access to pharmaceutical birth control, which remains unaffordable or unavailable for many financially disadvantaged women. Maternal obesity is often mischaracterized as a personal failing, but the data tell a different story. Structural and socioeconomic factors shape health outcomes long before pregnancy. Obesity is not the root problem—it is a symptom of deeper inequities in access to nutrition, health care, and preventive services.
What Causes Obesity? A Closer Look at Root Factors
Several factors play into the development of the medical condition known as obesity. Obesity is a medical condition characterized by excessive body fat relative to height, increasing the risk of serious health complications. These complications include hypertension, type 2 diabetes, arthritis, and high cholesterol. Obesity has also been linked to hypothyroidism, hormone imbalances, gut microbe imbalances, depression, and eating disorders. Furthermore, weight gain is a side effect of many pharmaceuticals used to treat chronic conditions, including insulin, antidepressants, antipsychotics, beta-blockers, and epilepsy medicines. Even doing things that are good for health, such as tobacco cessation, can cause rapid weight gain.
Apart from physical health and genetics, socioeconomic factors contribute to the development of obesity. Food insecurity is among the biggest health concerns for those who reside in low-income areas. Neighborhoods outside of wealthy areas often lack grocery stores and farmer’s markets that provide affordable, fresh, and whole foods. This leaves individuals of low economic status resigned to foods that are high in fat, sugar, and sodium. Additionally, people along the low-income threshold often work long hours that demand strenuous manual labor; it’s difficult to prepare a freshly cooked meal at the end of the evening.
Society often mischaracterizes obesity as a personal failing, but multiple factors contribute to excessive weight gain. Addressing these factors requires systemic solutions rather than simplistic mandates to lose weight.
Black women and women with low incomes who aren’t obese have an increased risk of pregnancy complications due to medical racism and a lack of affordable health care.
Health Risks of Obesity During Pregnancy
Excessive gestational weight gain puts pregnant people at risk of developing type 2 diabetes, preeclampsia, and heart disease. Other risks include miscarriage and stillbirth, sleep apnea, and an increased chance of having a C-section, according to the Mayo Clinic. For the baby, gestational obesity might put the infant at risk of birth defects, childhood asthma, and childhood obesity.
Missouri data reflects these risks. The pregnancy-related mortality ratio is highest among women with obesity, with 35.2 deaths per 100,000 live births—more than 2.5 times higher than for overweight women and double the rate for those with a healthy weight, according to the Missouri Pregnancy-Associated Mortality Review. These disparities highlight the urgent need for better maternal health care for pregnant people with obesity.
In many cases, women with obesity during pregnancy had the condition before conception. In Missouri, 30.7% of mothers had a prepregnancy body mass index (BMI) classified as obese (BMI > 30.0), based on data from the March of Dimes. A 2023 study published in JAMA found that losing weight during pregnancy is generally discouraged due to potential risks to the fetus, and no evidence suggests it reduces the chance of complications. It is important that people are given the tools to maintain their health both before and after pregnancy.
Black women and women with low incomes who aren’t obese have an increased risk of pregnancy complications due to medical racism and a lack of affordable health care. Obesity simply compounds these risks. In a study done by the University of North Texas Health Science Center, 25% of participants avoided regular doctor visits due to the weight bias from providers. This avoidance can be particularly harmful to Black women and people of color, who already face documented disparities in maternal health outcomes.
Preventive Care and Patient-Centered Solutions
Health care providers should work with expectant parents to develop individualized, realistic strategies for maintaining health throughout pregnancy. This includes identifying safe physical activities, accessible food options, and long-term preventive care to reduce future risks. Instead of focusing on weight loss—which can be dangerous during pregnancy—health care providers should guide expectant parents toward sustainable, long-term health strategies. As more research highlights the impact of weight bias in medical care, experts stress the importance of patient-centered approaches that focus on overall maternal health rather than weight alone. Lifestyle changes within the first trimester can lower the possibility of elevated blood glucose (sugar), according to the NIH.
Weight bias and stigma in health care create additional barriers for those already at risk of poor maternal outcomes. Reducing this bias is not just a matter of patient experience; it is critical for improving maternal and infant health.
Self-care and community support—both rooted in health equity—are critical to ensuring healthier outcomes for parents and children. Achieving health equity requires removing barriers that prevent people from receiving quality health care, regardless of race, gender, or socioeconomic status. This includes challenging the biases in maternal care that often leave pregnant people with obesity facing substandard treatment. Addressing these inequities is not just a moral imperative—it is essential to strengthening the nation’s deteriorating health infrastructure.
