Obesity is rising among women of reproductive age and significantly contributes to subfertility. If conception occurs, maternal obesity is associated with increased risks for both maternal and neonatal complications, with potential long-term effects on the offspring's health. Current clinical guidelines emphasize the importance of preconception weight optimization in women with obesity to reduce maternal and fetal risks. Amid the rising use of incretin-based anti-obesity medications, particularly among young women, their potential role in preconception care is receiving growing clinical and research interest. With unplanned pregnancies remaining common, incidental exposure during early pregnancy is becoming more likely. In parallel, there is increasing interest in the potential of these agents to support preconception weight loss and enhance fertility outcomes in women with obesity. This narrative review examines the current human evidence on GLP-1 and dual GLP-1/GIP receptor agonists approved for obesity treatment, focusing on their potential role in preconception care and addressing key safety considerations and challenges related to their use during the preconception period, as well as inadvertent exposure in early pregnancy.