Objective To study the effects of the gravida body mass index (BMI) and BMI alteration during pregnancy on pregnancy outcome and formulate the pattern of normal gravida weight increasing for pregnancy health care reference. Methods Total of 1 874 primigravidas were measured with gravida BMI and BMI alteration among pre-pregnancy, 28 gestational weeks and 40 gestational weeks. The pregnancy outcomes of different BMI groups were analyzed. Results The complications such as pregnancy-induced hypertension syndrome, cesarean section and fetal macrosomia showed higher frequency in high BMI group and intrauterine growth retardation showed frequently in low BMI group. There were statistically significant with normal BMI group. The frequency of complications such as pregnancy-induced hypertension syndrome, cesarean section and fetal macrosomia was significantly higher associated with BMI increasing during pregnancy. Conclusion BMI and BMI alteration during pregnancy were important predictors for pregnancy outcome.