Background: Iron deficiency anemia (IDA) is the most common nutritional disorder during pregnancy and remains a major public health challenge, particularly in developing countries. Maternal anemia is associated with increased risks of preterm delivery, low birth weight, postpartum hemorrhage, maternal morbidity, and perinatal mortality. Early identification and appropriate management are essential to improve maternal and fetal outcomes.Objective: To determine the prevalence of iron deficiency anemia and evaluate its associated demographic, clinical, and obstetric characteristics among pregnant women attending a tertiary care hospital.Methods: A hospital-based cross-sectional observational study was conducted among 320 pregnant women attending antenatal clinics over an 18-month period. Demographic characteristics, obstetric history, nutritional status, laboratory parameters, and iron studies were recorded. Iron deficiency anemia was diagnosed using hemoglobin concentration, serum ferritin, and peripheral blood smear findings according to international recommendations.Results: The mean age of participants was 26.9 ± 4.8 years. Overall prevalence of anemia was 56.3%, while iron deficiency anemia accounted for 46.9% of all pregnancies. Moderate anemia was the most common severity (41.3%). Multiparity, low socioeconomic status, inadequate iron supplementation, short birth interval, and poor dietary intake were significantly associated with iron deficiency anemia (p<0.05). Low serum ferritin (<15 ng/mL) was observed in 88.0% of women with iron deficiency anemia. Maternal fatigue (72.7%), pallor (68.0%), and dizziness (46.7%) were the most common clinical features.Conclusion: Iron deficiency anemia remains highly prevalent among pregnant women and is strongly associated with nutritional deficiencies and adverse socioeconomic conditions. Routine antenatal screening, nutritional counseling, iron supplementation, and early treatment are essential for improving maternal and neonatal health outcomes.