Cardiovascular disease remains the leading cause of morbidity and mortality among women globally, with growing evidence suggesting that cardiovascular risk can begin developing well before pregnancy, even during the preconception period. Among the most significant contributing factors is excess prepregnancy weight, which has been associated with a higher risk of adverse maternal and fetal outcomes, including hypertension-related disorders, gestational diabetes, preeclampsia, and long-term cardiovascular complications. As obesity rates continue to rise among women of reproductive age, preconception weight management has become an increasingly important area of focus in maternal and cardiovascular health. This review examines the relationship between prepregnancy weight and cardiovascular outcomes, explores the underlying mechanisms involved, and evaluates current evidence-based lifestyle interventions aimed at reducing cardiovascular risk before and during pregnancy.