Reasonable weight gain in pregnancy is essential for the health of the woman and fetus. The purpose of this secondary analysis was to examine patterns of prenatal weight gain in women with diabetes and hypertension using data from a randomized controlled trial examining physician-only (n = 29) versus APN and physician-delivered (n = 38) prenatal care. Data collection included gestational age at enrollment, delivery, diagnosis (diabetes, hypertension), prepregnancy body mass index (BMI), weight every 4 weeks during pregnancy, and total weight gain during pregnancy. Based on prepregnancy BMI, 21% of the sample was normal weight, 16% overweight, and 63% obese. There were no significant differences between physician versus APN and physician prenatal care and weight gained during pregnancy; the trend in favor of APN and physician care was evident. For women entering pregnancy with a chronic health condition, compounded by obesity, education on nutrition, diet, and behavioral modification is essential.