OBJECTIVE: to examine whether, among parous women, adherence to gestational weight gain (GWG) recommendations in the most recent previous pregnancy is associated with adherence to GWG recommendations in the current pregnancy.

DESIGN: retrospective cohort study.

SETTING: review of labour and delivery records from a Massachusetts tertiary-care centre.

PARTICIPANTS: 1,325 women who delivered two consecutive singletons from April 2006 to March 2010.

MEASUREMENTS: pre-pregnancy weight status and adherence to GWG recommendations were categorised using 1990 Institute of Medicine (IOM) guidelines. Analyses were stratified by weight status before the second pregnancy.

FINDINGS: 56% and 46% of women gained more than 1990 IOM recommendations during the first and second of consecutive pregnancies; 57% gained within the same adherence category in both pregnancies. Excessive GWG during the first pregnancy was strongly associated with excessive gain during the second pregnancy (adjusted odds ratio [AOR]=5.4 [95% CI: 1.7-16.4] for underweight, 3.7 [95% CI: 2.4-5.5] for normal weight, 3.0 [95% CI: 1.2-7.6] for overweight, and 5.3 [95% CI: 2.4-11.7] for obese women). Inadequate gain in the first of consecutive pregnancies was strongly associated with subsequent inadequate GWG for underweight women (AOR=13.7; 95% CI: 3.9-48.0), normal weight women (AOR=2.9; 95% CI: 1.7-5.1), and obese women (AOR=3.6; 95% CI: 1.4-9.3). Results were similar in sensitivity analyses using IOM 2009 guidelines.

KEY CONCLUSIONS: adherence to GWG recommendations in consecutive pregnancies is highly concordant.

IMPLICATIONS FOR PRACTICE: consideration of GWG during previous pregnancies may facilitate discussions about GWG during prenatal care.