Background: Anemia is a global health problem affecting both developing and developed countries with major harm full effects on human health as well as social and economic development. Anemia occurs due to deficiencies of essential nutrients, heavy blood loss and parasitic infections. Objective: The aim was to assess the prevalence of anemia and associated factor among pregnant women attending antenatal care at Ziquala district, North West, Ethiopia. Method: The Institutional base cross sectional study design was carried out from November to December, 2017. A total of 367 pregnant women were selected by simple random sampling method. Women were interview by using questionnaire and 3-4 ml blood samples was drawn. Data was entered using Epi info version7 and analyzed using SPSS version 20. Bivariable and multivariable logistic regression model was used to see the determinants of anemia. Results: The overall prevalence of anemia was 32.2% (118/367. Birth spacing less than two years (AOR=7.143, 95%CI(1.158-9.456)), take iron supplementation (AOR=.091 , 95% CI (.027-.303)), history of excessive menstrual bleeding (AOR=3.381, 95% CI (2.415-10.859)), consistence use bed (AOR=.061, 95% CI (.055-.471)), meal frequency twice or less per day (AOR=4.121(4.261-12.525)) and drink coffee always after meal (AOR=1.232(1.162-8.354))were factors significantly associated with anemia. Conclusion: The prevalence of anemia was 32.2%. Anemia was signifcatly associated with birth spacing ,meal frequncey and take iron supplimenion. Recommdation:Health professional providing ANC service should give health education on risk of short birth spacing and drinking coffee always immediately after meal. Health professional providing ANC service should give awareness creation on the importance of iron supplementation , consistence use of bed net and increasing the meal frequency per day