A number of reproductive outcomes have been increasingly found to be affected by the
vaginal microbiota. Obesity has become a global epidemic, has been affecting
increasing numbers of reproductive-age women, and has been shown to be a risk
factor for a number of adverse female health outcomes. A healthy vaginal microbiome
is characterised by Lactobacillus-dominance, in particular Lactobacillus crispatus;
obesity has been found to be associated with higher diversity and a lower likelihood of
Lactobacillus-dominance. In this review, we summarise the evidence on the vaginal
microbiome in obese women and the impact on reproductive outcomes such as
conception rates, early pregnancy and preterm birth. We further explore the
mechanisms by which obesity may result in an altered microbial composition, and
highlight future avenues for therapeutic targeting of the vaginal microbiota.