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ObjectivesTo assess the effectiveness of a brief behavioural intervention based on routine antenatal weighing to prevent excessive gestational weight gain (defined by US Institute of Medicine).DesignRandomised controlled trial.SettingAntenatal clinic in England.ParticipantsWomen between 10+0and 14+6weeks gestation, not requiring specialist obstetric care.InterventionsParticipants were randomised to usual antenatal care or usual care (UC) plus the intervention. The intervention involved community midwives weighing women at antenatal appointments, setting maximum weight gain limits between appointments and providing brief feedback. Women were encouraged to monitor and record their own weight weekly to assess their progress against the maximum limits set by their midwife. The comparator was usual maternity care.Primary and secondary outcome measuresExcessive gestational weight gain, depression, anxiety and physical activity.ResultsSix hundred and fifty-six women from four maternity centres were recruited: 329 women were randomised to the intervention group and 327 to UC. We found no evidence that the intervention decreased excessive gestational weight gain. At 38 weeks gestation, the proportions gaining excessive gestational weight were 27.6% (81/305) versus 28.9% (90/311) (adjusted OR 0.84, 95% CI: 0.53 to 1.33) in the intervention and UC group, respectively. There were no significant difference between the groups in anxiety or depression scores (anxiety: adjusted mean −0.58, 95% CI:−1.25 to –0.8; depression: adjusted mean −0.60, 95% CI:−1.24 to –0.05). There were no significant differences in physical activity scores between the groups.ConclusionsA behavioural intervention delivered by community midwives involving routine weighing throughout pregnancy, setting maximum weight gain targets and encouraging women to weigh themselves each week to check progress did not prevent excessive gestational weight gain. There was no evidence of psychological harm.Trial registration numberISRCTN67427351