Children born to overweight and obese women, as compared to those of normal weight women, have greater risk for becoming obese themselves and suffering comorbid metabolic health problems. Evidence is accumulating that this increased susceptibility is at least partially attributed to a prenatal programming effect, whereby obesogenic factors in the intrauterine environment alter fetal development of systems involved in body weight regulation thereby promoting deposition of excess adipose tissue. There is little evidence that maternal adipose tissue in and of itself is involved in programming the developing fetus toward obesity; rather, maternal obesity increases risk for metabolic health perturbations during pregnancy and it is these perturbations that appear to be involved in programming offspring risk for obesity. The considerable variability in the metabolic health of individuals, even among those of the same body mass index (BMI), highlights the fact that maternal BMI lacks precision for the identification of pregnancies that will convey increased risk of obesity to offspring. The purpose of the following review is to discuss evidence that maternal metabolic health is involved in the prenatal programming of obesity, and to identify simple maternal markers related to metabolic health, that may increase precision in the identification of obesogenic pregnancies. © Chandler-Laney and Bush.