Objectives <p>Oral health literacy (OHL) is an important determinant of oral health outcomes. Low parental OHL has been associated with higher rates of dental caries among children. This study examined OHL and factors associated with it among pregnant women in an urban area in Malaysia.</p> Methods <p>This cross-sectional study included a convenience sample of 455 pregnant women attending antenatal clinics in an urban district near Kuala Lumpur. Self-administered questionnaires collected sociodemographic information. OHL was measured using the validated Malay version of the 14-item Health Literacy in Dentistry Scale (MHeLD-14). HeLD-14 scores were analysed as a continuous variable, and associations between sociodemographic factors and OHL were explored using multivariable linear regression.</p> Results <p>The mean age of respondents was 29.7 years (SD 4.7). Of the 455 respondents, 439 had complete MHeLD-14 responses, and 418 were included in regression analyses after excluding cases with missing covariate data. The median OHL score was 52 (IQR 46-54.5; range 0–56). Item-level responses indicated greater difficulty with support-related items, such as bringing someone to a dental appointment, compared with utilisation-related items. In exploratory adjusted analyses, tertiary education was significantly associated with higher OHL scores, while Chinese and Indian ethnicity were associated with lower OHL scores compared with Malay respondents.</p> Conclusions for Practice <p>Respondents reported relatively high oral health literacy (OHL) scores. However, difficulties in support-related tasks suggest that practical and contextual barriers may limit the effective use of oral health services during pregnancy. These findings highlight the need for maternal oral health promotion strategies that go beyond information provision and address logistical and social barriers within antenatal care settings.</p>