Magnitude and determinants of gestational weight gain in Ethiopia: a systematic review and meta-analysis

Abstract

Abstract Background Gestational weight gain (GWG) 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. There is conflicting evidence about the magnitude and determinants of GWG in Ethiopia, no comprehensive synthesis has been conducted to summarize the overall prevalence and associated factors of GWG. Objectives Estimate pooled prevalence of GWG categories (inadequate, adequate, and excessive) and identify determinants among pregnant women in Ethiopia. Methods A systematic search was conducted in PubMed, Web of Science, African Index Medicus, Sciences Direct, and Google Scholar up to October 2025. Study quality was assessed via the Newcastle–Ottawa Scale. Pooled estimates were calculated via a random-effects model. Statistical heterogeneity was assessed via the I² statistic, and publication bias was evaluated using funnel plots and Egger’s test. Results Among the 13 included studies (n = 6,099), the pooled mean GWG was 9.93 kg (95% CI: 8.74–11.12). The pooled prevalence of adequate GWG was 41.3% (95% CI: 30.2–52.5), whereas inadequate GWG was highly prevalent at 52.8% (95% CI: 39.8–65.8). The prevalence of excessive GWG was relatively low 7.7% (95% CI: 4.6–10.9). Factors such as frequent meal intake ( > = 3/day) (OR = 2.92, 95% CI: 1.32–4.52), consumption of animal-source foods (OR = 2.70, 95% CI: 1.21–4.19), and > = 3 antenatal care visits (OR = 3.15, 95% CI: 1.47–4.82) were positively associated with adequate GWG. Pre-pregnancy underweight was a significant risk factor for inadequate GWG (OR = 3.31, 95% CI: 1.45–5.18), whereas urban residence was associated with an increased risk of excessive GWG (OR = 5.22, 95% CI: 2.43–11.22). Conclusion Ethiopia faces a dual burden of high inadequate GWG prevalence and emerging excessive GWG risk. Integrating tailored nutritional counseling and routine GWG monitoring into antenatal services, alongside context-adapted guidelines, is recommended for improving maternal and fetal health outcomes. Clinical trial number Not applicable.