Modern hyperprolific sows are increasingly susceptible to health challenges. Their rapid growth rates predispose them to locomotor disorders, while high metabolic demands, reduced backfat thickness, and increased protein accretion heighten their vulnerability to heat stress and dystocia. Additionally, prolonged farrowing negatively affects the oxidative and inflammatory status of these females. Additionally, prevalent conditions such as gastric ulcers and cystitis raise ethical, welfare, and economic concerns. Despite the several studies related to sow nutrition, there are no studies which compile and extrapolate nutrition approaches from the rearing period and their impact on sows’ health and longevity. Also, the aim of our review was to shed light on gaps that require further investigation. Controlling body condition scores is crucial for maximizing productivity in sows. During gestation, high-fiber diets help maintain optimal body condition and prevent constipation, particularly during the peripartum period. Antioxidants offer a range of beneficial effects during this critical phase. Additionally, probiotics and acidifiers can enhance gut health and lower the risk of genitourinary infections. On the day of farrowing, energy supplementation emerges as a promising strategy to reduce farrowing duration. Collectively, these strategies address major health challenges, enhancing welfare and promoting sow’s longevity.