Iron deficiency anemia (IDA) is a widespread nutritional disorder during pregnancy, particularly in low- and middle-income countries, where it contributes to maternal and neonatal morbidity. This study assessed the prevalence, symptoms, dietary habits, and risk factors of IDA among pregnant women attending the Government Maternity Hospital, Peshawar, Pakistan. A total of 200 women were surveyed using structured questionnaires and hemoglobin testing. Results showed that 76% were anemic, with higher prevalence in women aged above 26 years and in the third trimester (54.9%), where moderate and severe anemia predominated. Rural (72.11%) and hilly (88.24%) residents, women of low socioeconomic status (64%), and those without formal education (75.5%) were disproportionately affected. More than half of the anemic women were not taking iron supplements (51.97%). Dietary assessment revealed excessive tea consumption (80.27%) and low intake of milk (35.53%), fruits (34.86%), and vegetables (8.26%), reducing iron absorption. Common symptoms included dizziness (69.5%), headache (60.5%), and taste disturbance (60%), while major risk factors were multiparity (64.5%), poor nutrition (55.5%), vomiting (54.5%), poor compliance with supplementation (51%), heavy menses (24.5%), and abortion (20%). These findings highlight that IDA is highly prevalent among pregnant women in Peshawar, strongly linked to socioeconomic, dietary, and reproductive determinants. Effective interventions through nutritional education, iron supplementation programs, and improved maternal healthcare services are urgently needed to reduce the burden of IDA and ensure better maternal and fetal outcomes.