Background Pregnancy monitoring through timely antenatal care (ANC) is a cornerstone of maternal and neonatal health. However, in rural and underserved communities of northeastern Nigeria, numerous structural and sociocultural barriers continue to limit access to essential monitoring services, contributing to poor pregnancy outcomes. This study investigates the barriers influencing pregnancy monitoring in Potiskum and neighboring communities in Yobe State, Nigeria. Methods A retrospective cross-sectional study was conducted using electronic health records from Potiskum Medical Center between 2018 and 2023. Data from 14,846 pregnant women were analyzed. Adequate pregnancy monitoring was defined as having eight ANC visits and at least one ultrasound before 24 weeks of gestation. Bivariate and multivariate logistic regression analyses were performed to identify predictors of inadequate monitoring. Results Women aged >
35 had the highest odds of inadequate pregnancy monitoring (adjusted odds ratio (AOR): 4.66, 95% CI: 3.94-4.66, p <
0.002), with elevated risks also observed in the 26-30 (AOR: 2.62, 95% CI: 2.32-2.81) and 30-35 age groups (AOR: 2.78, 95% CI: 1.42-3.92
both p <
0.002). Low education (AOR: 2.62, 95% CI: 2.11-2.72, p <
0.01), unemployment (AOR: 2.32, 95% CI: 2.12-2.85, p = 0.002), and lack of health insurance (AOR: 2.69, 95% CI: 1.99-2.73, p <
0.0002) were strong predictors, while tertiary level of education reduced the risk (AOR: 0.42, 95% CI: 0.24-0.48, p <
0.0002). Limited decision-making autonomy (AOR: 3.74, 95% CI: 3.22-4.03, p <
0.0002) increased the odds of inadequate monitoring, whereas absence of negative healthcare experiences (AOR: 0.12, 95% CI: 0.08-0.41) and non-adherence to traditional beliefs (AOR: 0.14, 95% CI: 0.10-0.22
both p <
0.0002) were protective factors. Conclusion A combination of socioeconomic disadvantage, cultural norms, and health system shortcomings drives inadequate pregnancy monitoring in rural Yobe State. Interventions that promote women's autonomy, expand insurance coverage, address traditional misconceptions, and improve patient experiences within healthcare facilities are urgently needed to improve ANC utilization and maternal health outcomes in underserved Nigerian communities.