Back ground: Coronavirus disease-2019 is a newly emerging respiratory disease caused by a novel coronavirus or severe acute respiratory syndrome coronavirus-2. Objectives: To determine practice of preventive measures of COVID-19 and identify associated factors among pregnant women attended antenatal care in Adiarkay district health facilities Northwest Ethiopia 2021. Methods: A facility based cross- sectional study design was conducted from March to April 2021.The study population were pregnant women who attended antenatal care follow up visit during data collection time and were selected using Systematic sampling technique. Data were coded and entered into EPI data version 3.2 and exported to SPSS version 23 for analysis. Bi- variable logistic regression analysis were done. Thus, independent variables with probability value less than 0.25 were considered in the final model. The model fitness was checked by using Hosmer-Lemeshow model fitness test with probability value (0.99). Then Multivariable Logistic regression analysis was done to identify the factors associated with practice of preventive measures of COVID-19. A statistical significance level were consider at a Probability value of less than 0.05, and strength of association was explained by odds ratio. Results: A total of 458 pregnant women were participated in this study .This study, showed that 241 (52.6%; 95% CI= 48.3-55.7) of participants had good level of practice of preventive measures of COVID-19. Pregnant women who had primary education status (AOR: 4.51; 95% CI: 2.66-7.6), had secondary education status (AOR: 2.45; 95% CI: 1.05-5.66), had college and above educational status (AOR: 5.81; 95% CI: 2.48-13.58), had three antenatal care follow up (AOR 2.12; 95:1.13-3.96) had four antenatal care follow up (AOR 2.59; 95% CI: 1.03-6.5), heard information from television and radio (AOR 3.54; 95% CI: 1.36-9.22) and had good attitude (AOR: 2.3; 95% CI: 1.3-4.0) were significantly associated with good practice of preventive measures of COVID-19. Conclusion: This study finding showed that good practice of preventive measures of COVID-19 was 52.6% which was low. Pregnant women’s educational status, longer antenatal care follow up, good attitude, and heard from television and radio about COVID were statistically significant with good preventive measures of COVID-19.