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Background: Increasing numbers of women are entering pregnancy with an elevated body mass index (BMI). Elevated maternal BMI is associated with a number of adverse obstetric and neonatal outcomes, however attention to diet and lifestyle during the antenatal period has been shown to reduce the rate of many of these complications. The Obesity, Pregnancy and Lifestyle (OPAL) clinic was started at the Northern Hospital in July 2018 to provide specialised antenatal care to women with Class III obesity (BMI ≥ 40 kg/m2). Methods: We performed a retrospective cohort study of women with a BMI ≥ 40kg/m2 delivering a singleton pregnancy at the Northern Hospital, Melbourne, Victoria, between January 2019 and April 2020, comparing obstetric and neonatal outcomes of women who attended the OPAL clinic (n=60) to those who received standard antenatal care (n=121). Statistical analysis performed using χ2, Fisher’s Exact Test, Student’s T-test and Mann-Whitney (rank sum) test with a significance level of 0.05.Results: Compared to similar women in standard antenatal care, women who attended the OPAL clinic are more likely to be younger (mean age 29 vs 32, p = 0.001), to be primiparous (OR 2.65 (1.33-5.28), p = 0.005) and to be born in Australia or New Zealand (OR 0.47 (0.22-1.03), p = 0.057).OPAL women also attended a significantly higher number of antenatal appointments (9 vs 8, p=0.017) and had a lower median gestational age of delivery (38.3 vs 38.5, p=0.024).Conclusions: These results suggest that the OPAL clinic has achieved increased engagement of women with class III obesity in antenatal care. However, significant demographic differences indicate there is a subset of women still not receiving specialist care despite best intentions, indicating clinic processes are in need of review. Future research should focus on the patient experience of women attending the OPAL clinic.