**Abstract**

Obese women with metabolic syndrome are at increased risk for cardiothrombo-metabolic dysfunction that leads to pregnancy-related venous thromboembolism (VTE), hypertensive disorders of pregnancy (HDP), and gestational diabetes mellitus (GDM). Indeed, maternal death secondary to a pregnancy-related VTE has an enormous impact on the childbearing population. Recent research has provided evidence that elucidates the pathogenesis of adverse outcomes in obese pregnant women with metabolic syndrome. The chronic inflammation elicited by dysregulated infiltration of macrophages into adipose tissue and increased thrombin generation by inflammatory cytokines with activation of the tissue factor pathway may play important roles in the pathogenesis; however, a simple question has yet to be answered. Specifically, "why does prepregnancy obesity increase the risk of pregnancy-related VTE in association with a high estrogenic and prothrombogenic state?" The present review of the extant literature has focused on further understanding obesity-related adverse outcomes in pregnancy by elucidating the underlying pathogenesis of metabolic syndrome.

**Keywords:** obesity, metabolic syndrome, pregnancy-related venous thromboembolism, hypertensive disorders of pregnancy, gestational diabetes mellitus, inflammatory cytokines, thrombin formation, estrogen
