LeBlanc ES, Smith NX, Vesco KK, et al. - Researchers sought to ascertain if and how prepregnancy weight loss influences gestational weight gain and pregnancy outcomes. They conducted a pragmatic randomized clinical trial between May 2015 and October 2019 at Kaiser Permanente Northwest, an integrated health system, including 326 women who were aged 18 to 40 years, had a body mass index of ≥ 27 kg/m ² and were planning pregnancy within 2 years. Participants were randomized to either a behavioral weight loss intervention or usual care control. Among these women, 169 had singleton pregnancies lasting ≥ 14 weeks (analytical cohort: intervention, 89; control, 80). More weight loss before pregnancy was reported by participants in the intervention group than those in the control group. No effect on women’s likelihood of exceeding gestational weight gain guidelines was observed among participation in the prepregnancy weight loss intervention. Despite successful weight loss before conception, greater weight gain in late pregnancy was observed in the intervention group. Based on findings, they suggest combining prepregnancy weight loss interventions with intensive weight management that continues throughout delivery in order to attain effective reduction in weight throughout pregnancy and improvement in maternal and child outcomes.