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/m 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.