Background: The present study aimed to evaluate the adherence to nutritional counselling goals among pregnant women with overweight and its effect on perinatal outcomes.

Methods: A randomised clinical trial was conducted in 350 adult pregnant women with overweight (BMI 25-29.9 kg/m²). The women were assigned to control (CG = 166) or intervention groups (IG = 169). Women in the IG received three individual nutritional counselling sessions during pregnancy. Goals were related to the consumption of home-cooked meals, fruits, vegetables, physical activity and avoidance of ultra-processed foods. A score of 1 point was given for each goal achieved. Goals adherence was defined as achieving at least four out of the six goals established (overall score ≥ 4 points), regardless of the treatment group. Adjusted logistic and linear regression models were used to assess the association between goal adherence and perinatal outcomes.

Results: In the IG, 54.7% of pregnant women achieved overall goal adherence, compared to 31.7% in the CG (p = 0.001). A negative association was observed between the overall goal adherence score and total cholesterol (TC) (β -7.56 [95% CI -15.50; -0.62], p = 0.03) and low-density lipoprotein cholesterol (LDL-c) (β -8.43 [95% CI -14.96; -1.91], p = 0.01]. Additionally, physical activity time was negatively associated with TC and LDL-c. A higher frequency of consumption of sugary beverages was positively associated with TC. No association was observed for other perinatal outcomes investigated.

Conclusion: Adherence to the goals of counselling showed a beneficial effect, being negatively associated with TC and LDL-c in pregnant women with overweight.

Keywords: Nova classification system; nutritional counselling; perinatal outcomes; physical activity practice; pregnant women.

© 2025 The British Dietetic Association Ltd.