Under Nutrition and Associated Factors among Pregnant Women Residing in Productive safety net program beneficiary and non-beneficiary households In West Belesa District, Northwest Ethiopia

Malnutrition affects approximately 462 million pregnant women globally. Despite initiatives like the Productive Safety Net Program (PSNP) in Ethiopia, evidence comparing maternal undernutrition between PSNP beneficiary and non-beneficiary households remains limited. This study aimed to compare undernutrition and its associated factors among pregnant women in West Belessa District, Central Gondar Zone. A community-based comparative cross-sectional study was conducted from April 1–30, 2025, among 617 randomly selected pregnant women. Data were collected through face-to-face interviews, and nutritional status was assessed using Mid-Upper Arm Circumference (MUAC). Data entry was done using EpiData 3.1 and analyzed with STATA 14. Bivariate and multivariate logistic regression analyses identified factors associated with undernutrition, with significance set at p < 0.05. Model fitness was assessed using the Hosmer–Lemeshow test. The overall prevalence of undernutrition was 44.4% (95% CI: 40.5–48.5). Factors significantly associated with undernutrition included poor nutritional knowledge AOR = 5.73, 95% CI: 3.9–8.4, no prenatal dietary advice AOR = 1.89, 95% CI: 1.27–2.83, poorest wealth index AOR = 3.24, 95% CI: 1.75–6.0, and no habit of eating snacks AOR = 1.47, 95% CI: 1.04–2.16. Undernutrition among pregnant women in West Belessa District remains high. Improving nutritional knowledge, promoting dietary counseling during antenatal care, and addressing socioeconomic disparities are essential to reduce maternal undernutrition.