Background <p>Physical activity during pregnancy is essential as it impacts maternal and fetal outcomes. Understanding physical activity patterns helps refine guidelines specific to pregnant women. This study aims to assess current physical activity levels in pregnant women, identify associated factors, and compare their pregnancy activity to pre-pregnancy levels.</p> Methods <p>This cross-sectional study was conducted from September 2023 to January 2024. It included pregnant women in all trimesters who were receiving prenatal services from three PHCs, one multi-speciality, one maternity home, and one private clinic in rural and urban Puducherry, respectively. Participants enrolled at these study sites were interviewed to determine their physical activity level before and during pregnancy, which was then categorized based on the energy costs they spent. Additionally, 10% of the participants received a pedometer for one month to measure their daily step count.</p> Results <p>Out of the 225 pregnant women who participated in this study, 89.8% had sedentary activity levels. Employment status was significantly related to sedentary behavior (aPR = 3.5, 95%CI = 2.1–5.9, <i>p</i> value &lt; 0.001). Before pregnancy, 20% of participants had low physical activity levels. There was moderate agreement between the physical activity levels determined using the questionnaire and pedometer, Cohen’s <i>κ</i> = 0.41, <i>p</i> &lt; 0.05.</p> Conclusion <p>Physical activity levels among pregnant women were found to be inadequate, particularly given the high prevalence of obesity and other comorbidities. Further research on reasons for increased sedentariness during pregnancy and barriers to physical activity is needed. Strategies for physical activity counselling and culture-specific interventions in routine antenatal care can be developed.</p>