Background <p>Cognitive dysfunction is a significant contributor to mental health complexities during pregnancy, potentially leading to heightened rates of pregnancy-related mortality and inadequate prenatal care. However, limited research has been conducted to explore the relationship between pregnancy and cognitive decline, especially in low-income settings such as Pakistan. Therefore, this study aimed to establish a clear link between cognitive function and pregnancy.</p> Methods <p>A cross-sectional comparative study was conducted at a tertiary care hospital in Karachi, Pakistan with a sample size of 160 participants, divided into two groups of 83 pregnant (aged 25.63 ± 4.22) and 77 nonpregnant women (aged 27.79 ± 3.89). First, the participants were interviewed to collect demographic information and pregnancy status. Then, the Montreal Cognitive Assessment (MoCA) scale, which evaluates cognitive function across multiple domains, including visuospatial/executive function, naming, attention, language, abstraction, delayed recall, orientation, and memory was used on each group separately. The analysis investigated the relationship between cognitive function and pregnancy, considering the influence of low-income status and gestational age. The statistical analyses included Spearman Rho (for non-normal data), t-tests, and linear regression models. T-tests were used to compare the means of MoCA scores between different groups and to analyze the effect of pregnancy status on the specific domains of MoCA. Multiple linear regression models were employed to examine the relationships between MoCA scores and various predictors, such as pregnancy status, education level, gestational age, and active complaints.</p> Results <p>The study found a significant difference in MoCA scores between pregnant and nonpregnant women (B=-1.55, t=-2.37, <i>p</i> = 0.019), indicating a decline in cognitive function during pregnancy. Education level (B = 2.34, t = 8.38, <i>p</i> = 0.000) and gestational age (B=-1.61, t=-2.51, <i>p</i> = 0.014) were identified as significant factors influencing cognitive function. Higher education was associated with better cognitive function while increasing gestational age correlated with a decline in cognitive function. In addition, active complaints (B=-1.86, t=-2.25, <i>p</i> = 0.028) during pregnancy were associated with lower MoCA scores.</p> Conclusion <p>Our preliminary analyses suggest that there is notable cognitive impairment associated with pregnancy. More attention and research in this aspect can contribute to better prenatal care and promote the well-being of pregnant women.</p>