Introduction <p>Rates of gestational diabetes (GDM) are increasing alarmingly, especially in low- and middle-income countries. Although reducing risk is possible through different prevention measures, there is a lack of exploratory evidence in the Ethiopian context.</p> Objective <p>This study aimed to explore pregnant women’s awareness and prevention strategies on gestational diabetes mellitus.</p> Method <p>A descriptive qualitative study was conducted in the Jimma, Oromia region, Southwest Ethiopia, from March 2 to April 10, 2024. A purposive sampling approach was used, and in-depth interviews were conducted by trained data collectors. The interviews were audio recorded and transcribed verbatim by the research team on a daily basis.</p> Result <p>Thematic analysis was performed for the transcripts, and three broad themes emerged: understanding GDM, lifestyle changes (a healthy diet and exercise) and the effects of GDM on both mothers and babies. The findings indicate a range of gaps in women’s understanding of how lifestyle changes (diet and exercise) reduce the risk of GDM. Gaps included misconceptions regarding GDM, an incomplete understanding of lifestyle risk factors, limited awareness of the effect GDM has on mothers and babies, and inconsistent views of recommended physical activity during pregnancy.</p> Conclusion <p>The findings identified the lack of awareness on GDM and its prevention strategies. Misconception on the adverse GDM outcomes and insufficient comprehension of lifestyle-related risk factors. The findings of this study may suggest that women need health information on GDM prevention diets and exercise during antenatal care.</p>