Background: In underdeveloped nations, pregnant anaemia is a serious public health issue and is linked to poor mother and foetal outcomes. This study examined the prevalence, risk factors, and severity of anaemia in pregnant women attending the ANMMCH, Gaya prenatal outpatient clinic. Methods: This prospective, cross-sectional study examined 100 pregnant women from December 2023 to November 2024. Based on WHO guidelines, haemoglobin levels were measured and anaemia categorized. Analyses included demographics, nutrition, and test results. Results: The frequency of anaemia was 68%, with 59% microcytic hypochromic. The third trimester had the greatest anaemia (82%), and poor socioeconomic level (82%), vegetarian diet (74%), and multiparity (65%) were risk factors. 61% of anaemic women had low serum ferritin levels (<20 ng/mL), indicating iron insufficiency as the main reason. Conclusion: Anemia remains a significant burden in pregnancy, necessitating early screening, nutritional interventions, and better antenatal care to reduce maternal and neonatal complications.