Magnitude and factors associated with gestational weight gain among pregnant women in East Gojjam Zone, Northwest Ethiopia

• Inadequate gestational weight gain was highly prevalent among pregnant women in the study setting (65.5%). • Only 29.2% of participants were achieved adequate gain. • Rural residence and fasting during pregnancy were significant determinants of lower GWG. • Antenatal exercise, maternal education, and nutritional counseling were positively associated with GWG. • Strengthening ANC-based nutritional counseling and lifestyle support may improve maternal and neonatal outcomes. Gestational weight gain is a key determinant of maternal and neonatal health and is strongly associated with pregnancy outcomes as well as long-term risks, including obesity and metabolic disorders. Despite its clinical importance, evidence on gestational weight gain patterns and their determinants remains limited in Ethiopia. This study aimed to assess magnitude of gestational weight gain and its determinants in East Gojjam Zone public health hospitals northwest Ethiopia. An institutional-based prospective cohort study was conducted among 415 systematically selected women from June 20, 2024, to May 30, 2025. Data were collected using interviewer-administered questionnaires, as well as medical record reviews. Multivariable linear regression was used to examine associations between potential determinants and gestational weight gain. The mean gestational weight gain was 9.7 ± 3.06 kg. Overall, 66.5% of women experienced inadequate gestational weight gain, 29.2% achieved adequate gain, and 4.3% had excessive gestational weight gain. Rural residence (β = –0.91; 95% CI: –1.64, –0.18) and fasting during pregnancy (β = –1.64; 95% CI: –2.19, –1.09) were negatively associated with gestational weight gain. In contrast, regular antenatal exercise (β = 1.52; 95% CI: 0.63, 2.42), higher educational attainment (β = 1.65; 95% CI: 0.81, 2.48), and receipt of nutritional counseling (β = 1.51; 95% CI: 0.75, 2.27) were positively associated with gestational weight gain. Inadequate gestational weight gain remains highly prevalent among pregnant women in the study setting. Rural residence, fasting during pregnancy, educational status, antenatal physical activity, and lack of nutritional counseling were identified as key determinants of gestational weight gain. Strengthening routine clinical monitoring and implementing context-specific nutritional and lifestyle interventions are essential to promote appropriate gestational weight gain and improve maternal and neonatal health outcomes.