Background: Adverse maternal and infant outcomes can arise from excessive maternal gestational weight gain. Overweight and obese women are most at risk for excessive gestational weight gain. The Institute of Medicine (IOM) has established gestational weight gain ranges for pregnant women based on their pre-pregnancy BMI. Pregnant women’s perceptions of IOM recommendations, however, have not been well documented in the literature. Objective: This study was to explore (1) if pregnant women had received weight gain advice from care providers; (2) preferred weight gain amount by pregnant women and why; and (3) how possible to achieve IOM recommended weight gain. Design: Quantitative and qualitative content analyses were used. Participants: 13 overweight and obese pregnant women (77% African American, 23% were first pregnancy) participated in this study. Methods: Semi-structured interviews were conducted and audio-taped. Quantitative content analysis involved calculating frequencies and percentages. Qualitative content analysis included coding transcribed interviews and identifying common themes from codes. Results: 69% of study participants did not receive weight gain advice from care providers; 54% of the women whose preferred weigh gain was not in accordance with IOM recommendations. Study participants reported two reasons why they chose their preferred weight gain amount: it would be hard to lose extra weight and the weight gain is for the health of the baby. Study participants voiced different levels of confidence in achieving IOM recommended weight gain, from possible to needing support, difficult to stay within the recommended range, out of personal control, and creating additional stress. Conclusions: Findings indicate that missed opportunities from care providers to educate pregnant women about proper weight gain. Although many pregnant women do not want to put on extra pounds, they need education about proper weight gain based on individual BMI status as well as support to help them achieve IOM recommendations.