PIP: This study determines knowledge, attitude, and practice of diet and nutrition during pregnancy among women in Karachi, Pakistan. Quantitative and qualitative data were obtained from a randomized convenience sample of 150 pregnant women from outpatient clinics of 3 hospitals: Aga Khan University Hospital (AKUH), Karachi Adventist Hospital, and Civil Hospital. Daily caloric intake was based on a single day. Two dietary patterns were observed. Meals among individuals with monthly income under Rs. 5000 consisted of flatbread, lentils, and/or vegetables. Meat was eaten under twice/week. Calories came primarily from flatbread, cereals, and cooking oil. Those with income over Rs. 10,000/month ate a great variety of foods and meat frequently. The source of calories was diverse and more balanced. The women preferred milk and fresh fruit during pregnancy. Milk was desired for fetal bone development, enhanced lactation, good skin, and a settled stomach. Desired foods were described as cold and justified since the womb was a source of heat production. Lower socioeconomic status (SES) groups did not trust their judgment about beneficial foods and could not afford the foods they desired. Many women had food avoidances, such as hot foods. The percentage of women with food avoidances increased with increased SES. Most women valued increased food consumption during pregnancy, but 68% did not increase their caloric intake and 40% decreased caloric intake. The mean caloric intakes, from low to high SES, were 1087, 1656, and 1750 kcal/day/woman, respectively.