Background: Refractive error is a common problem of pregnant women and responsible for both short and long-term impacts. Despite its impact, the magnitude and associated factors of refractive error among pregnant women in Ethiopia is still unknown. This study aimed to determine the prevalence of refractive error and its associated factors among pregnant women attending antenatal care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2020.

Methods: An institution-based cross-sectional study was employed. Ocular examination was done using Retinoscope and Snellen’s illiterate “E” Chart. We used the interviewer-administered questionnaire to collect the required data consisting of socio-demographic, clinical and pregnancy-related variables. Epi data 3.02 and STATA 14 were used for data entry and analysis respectively. Both bivariable and multivariable binary logistic regression analyses were executed to identify factors associated with refractive error. Variables with a p-value ≤ 0.05 in the multivariable logistic regression analysis were declared as significant factors.

Results: A total of 401 pregnant women participated in this study. The median age of study participants was 27 (IQR=24-31) years. The overall prevalence of refractive error among the study participants was 35.66% (95% CI: 30.95-40.37). Out of the total study participants, 22.90% of them were myopic, 11.22% hyperopic and the rest were antimetropic. Increased maternal age (Adjusted odds ratio) (AOR=1.31; 95% CI: 1.16-1.48)), increased parity (AOR=3.17, 95% CI: 1.92-5.25), increased gestational age (AOR=1.15, 95% CI: 1.08-1.22), and regular use of computers/ watching television (AOR=6.19, 95% CI: 2.46-15.59) were positively associated with refractive error.

Conclusion: The prevalence of refractive error among pregnant women was high where myopia was the most common variety. Advanced maternal age, increased gestational age, increased parity and regular use of computers or watching television were significantly associated with refractive error among pregnant women. Apart from providing other maternal health services, routine screening and evaluation of pregnant women for refractive error during antenatal care visit is recommended to avoid its negative impacts.