Introduction: worldwide the average prevalence of anemia among pregnant women is 38.2% and in Ethiopia, the average prevalence of anemia among pregnant women is 22%. The aim of this research was to identify risk factors of anemia among pregnant women in Eastern Zone of Tigray, Ethiopia.

Methods: a case-control study was conducted among 600 (150 cases and 450 controls) pregnant women in 2017/18. Pregnant women with a hemoglobin level below 11 g/dl were cases (anemic) and those with hemoglobin >11 g/dl were controls (non-anemic). Data were collected using structured questionnaire and SPSS version 20 was used for analysis. Bivariate and multivariate logistic regression model was used to identify the risk factors for anemia among pregnant women. P-value <0.05 and adjusted odds ratio with a 95% confidence interval were used to assess the association.

Results: intestinal parasites (adjusted odds ratio (AOR)=3.4; 95% confidence interval (CI): 1.2, 17.9), farmer occupation (AOR=3, 95% CI: 1.4, 10.8), unprotected sources of drinking water (AOR=3; 95% CI: 1.7, 16.9), drinking coffee/tea with or immediately after meal daily (AOR=1.9; 95% CI: 1.04, 8.7) and diet diversity score (DDS) of less than 3 (AOR=3; 95% CI: 1.5, 5.5) were statistically significant for anemia among pregnant women.

Conclusion: in this study, the risk factors for anemia among pregnant women were intestinal parasites, mother farmer occupation, unprotected source of drinking water, drinking coffee or tea with a meal or immediately after meal and low diet diversification score. Therefore, nutritional intervention should consider the above-identified risk factors.