ABSTRACT: INTRODUCTION:Weight gain during pregnancy is an important indicator of maternal and fetal nutrition during pregnancy. However, information regarding the effect of pregnancy weight gain on birth weight is lacking from developing countries. OBJECTIVE:To determine the effect of pregnancy weight gain on the newborn's birth weight in mothers attending antenatal care (ANC) services from private clinics. METHODS:Health facility-based follow-up study was conducted among 332 pregnant mothers attending their antenatal care in Mekelle city, from October 2016 to June 2017. Before 28 weeks of gestation, pregnancy weight was collected retrospectively, then, mothers were followed-up until the time of infant delivery to record their birth weight. Data were also collected by a structured questionnaire and checklists and analyzed using SPSS version 21. The relationship between dependent and independent variables was assessed and presented using descriptive statistics, as well as t-test, ANOVA, and multivariable linear regression analysis. Variables:-pre-pregnancy BMI, maternal age, parity, decision making power on monetary resources, pregnancy interval, availability of housemaid, women dietary diversity score, maternal occupation, and pregnancy weight gain were included in the multivariable analysis. RESULTS:Maternal weight increased monthly at a mean ± SD rate of 2 ± 0.7 kg in the second trimester, and 1.5 ± 0.7 kg in the third trimester. The mean ± SD of pre-pregnancy body mass index (BMI) and total pregnancy weight gain was 23.8 ± 4.6 kg/m2, and 12 ± 2.8 kg respectively. The mean ± SD of birth weight was 3440 ± 542 grams. Weight gain has a significant effect on infant birth weight, a 1 kg increase in the pregnancy weight was associated with 94 g increase in BW (? = 97, 95% CI: 73-120). After dividing the pre-pregnancy weight into four groups (< 18.5, 18.5-24.9, 25-29.9 and ?30) kg/m2 based on the Institute of Medicine (IOM), we found a statistically significant birth weight difference between each group. CONCLUSION:Pregnancy weight gain has a significant effect on birth weight. Thus, ANC counseling services should focus on maternal weight gain to prevent sub-optimal birth weight.