AbstractBackgroundExpert groups recommend that women set a pregnancy weight gain goal with their care provider to optimise weight gain.ObjectiveOur aim was to describe the concordance between first‐trimester personal and provider pregnancy weight gain goals with the Institute of Medicine (IOM) recommendations and to determine the association between these goals and total weight gain.MethodsWe used data from 9353 women in the Nulliparous Pregnancy Outcomes Study: monitoring mothers‐to‐be. In the first trimester, women reported their personal pregnancy weight gain goal and their provider weight gain goal, and we categorised personal and provider weight gain goals and total weight gain according to IOM recommendations. We used log‐binomial or linear regression models to relate goals to total weight gain, adjusting for confounders including race/ethnicity, maternal age, education, smoking, marital status and planned pregnancy.ResultsApproximately 37% of women reported no weight gain goals, while 24% had personal and provider goals, 31% had only a personal goal, and 8% had only a provider goal. Personal and provider goals were outside the recommended ranges in 12%‐23% of normal‐weight women, 31%‐41% of overweight women and 47%‐63% of women with obesity. Women with both personal and provider pregnancy weight gain goals were 6%‐14% more likely than their counterparts to have a goal within IOM‐recommended ranges. Having any goal or a goal within the IOM‐recommended ranges was unrelated to pregnancy weight gain. Excessive weight gain occurred in approximately half of normal‐weight or obese women and three‐quarters of overweight women, regardless of goal setting group.ConclusionsThese findings do not support the effectiveness of early‐pregnancy personal or provider gestational weight gain goal setting alone in optimising weight gain. Multifaceted interventions that address a number of mediators of goal setting success may assist women in achieving weight gain consistent with their goals.