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To examine the association between actual and perceived overweight/obese status and excess gestational weight gain (GWG). As part of an infant feeding trial, multi-ethnic lower and moderate income women-completed a checklist of current health conditions, including 'overweight/obesity,' 'asthma,' and 'hypertension' while pregnant. Odds of excessive GWG per the Institute of Medicine guidelines in 'accurate' versus 'inaccurate' reporters, by overweight status were analyzed with multivariate logistic regression for women with pre-or early pregnancy BMIs of ≥ 18.5. 775 women met study criteria. Just 21% (n = 107) of overweight/obese women accurately identified their weight status, compared to >90% accurate report of documented hypertension or asthma. Compared to normal-weight accurate reporters, the adjusted odds of excessive GWG in overweight/obese women was 2.3 (95% CI 1.4, 3.7) in accurate reporters, and 2.5 (95% CI 1.7, 3.4) in inaccurate reporters. Overweight/obesity is associated with excessive GWG, but this risk is not modified by inaccurate reporting/perception of weight-status. Keywords Gestational weight gain * Obesity * Weight perception * Body-mass index, Introduction Adverse neonatal and obstetric effects of pre-pregnancy obesity include pregnancy-induced hypertension, pre-eclampsia, gestational diabetes, cesarean section, and neonatal death [1-6]. More recently, gestational weight gain (GWG) has been linked [...]