This study investigated the prevalence of abnormal neuropsychomotor developmental performance and associated factors in children enrolled in the public preschool system in Feira de Santana, Bahia State, Brazil, 2009 (N = 438). This was a cross-sectional epidemiological study with random sampling of schools and children. The study analyzed associated factors with a questionnaire applied to mothers and the Denver Developmental Screening Test (DDST) II in the preschool children. Statistical analysis used the χ(2) test with 95% confidence interval and α = 5%. Prevalence of abnormal developmental performance was 46.3%. According to logistic regression analysis, variables showing statistically significant association were: male gender (PR = 1.43; p = 0.00), age five years (PR = 1.42; p = 0.00), lack of prenatal care (PR = 1.41; p = 0.00), first prenatal visit ≥ 3 months gestation (PR = 1.25; p = 0.00), and alcohol consumption during pregnancy (PR = 1.55; p = 0.00). Prevalence of abnormal development was high, thus highlighting the need for early prenatal care, warnings against alcohol consumption during pregnancy, and early childhood monitoring, aimed at prevention or early treatment.