Pregnancy is a critical period when women are particularly vulnerable to nutritional deficiencies. However, limited evidence exists on nutritional knowledge, dietary practices, and associated factors among pregnant women in the study area.

To assess nutritional knowledge, dietary practice, and associated factors among pregnant women in Halaba town.

A concurrent mixed-methods cross-sectional study was conducted in Halaba Town from August 2 to November 25, 2025. Quantitative data were collected from 403 randomly selected pregnant women, while qualitative data were obtained from five FGDs with 35 purposively selected participants. Data were collected through face-to-face interviews and analyzed using descriptive and thematic analyses.

Of the 403 selected participants, 398 pregnant women completed the study, yielding a response rate of 97.7%. Half of the respondents (51%) had good nutritional knowledge, yet only 42.4% of pregnant women reported practicing healthy dietary behaviors. Educational status (AOR: 2.0; 95% CI: 1.3–4.2), pregnancy status (AOR: 2.3; 95% CI: 1.5–4.5), and nutritional information (AOR: 3.1; 95% CI: 1.5–4.9) were significantly associated with nutritional knowledge. Educational status (AOR: 1.9; 95% CI: 1.4–4.3), nutritional information (AOR: 3.9; 95% CI: 2.5–7.9), occupational status (AOR: 1.7; 95% CI: 1.3–4.1), and food security status (AOR: 1.9; 95% CI: 1.5–5.4) were significantly associated with dietary practices. Qualitative findings showed that cultural food taboos and economic constraints limited dietary diversity, while spousal support, shared decision-making, and home gardening promoted healthier dietary practices.