Background and Objective: Pre-pregnancy obesity is commonly associated with adverse pregnancy outcomes like cesarean deliveries and preterm birth rates. Cesarean deliveries are associated with excessive bleeding, which is a common cause of maternal mortality. Preterm births may lead to physical and psychological disorders in children. This study aims to highlight the prevalence of pre-pregnancy obesity and examine the potential impact of ignoring pre-pregnancy obesity in the expenditure of MCH title V Grants on preterm and cesarean deliveries. Method: statewise secondary data was collected for pre-pregnancy obesity rates from the NCHS website. Preterm and cesarean birth rates were calculated from CDC database. Statewise percentage increase in pre-pregnancy obesity from 2016 to 2019 was grouped into four categories: 1) 14% and over, 2) between 10% to 13.9%, 3) less than 10%, and 4) no significant change. SAS software was used for regression analysis to find association between pre-pregnancy obesity and preterm and cesarean births. Results: Pre-pregnancy obesity is significantly associated with preterm (P < 0.0001) and cesarean births (P < 0.0064). On average, there has been an increase in pre-pregnancy obesity from 2016 to 2019 in each cluster. However, on comparing the pre-pregnancy obesity clusters, there is no significant difference in the average spending of title V grants. Conclusion: Pre-pregnancy obesity has adverse maternal and infant health outcomes, and there is an urgent need to address this issue. State governments must consider pre-pregnancy obesity as a public health concern and divert a portion of Title V MCH grant funds to address the issue.