Introduction <p>Exposure to extreme heat during pregnancy is associated with adverse maternal and child health outcomes. Heat-health protective actions such as spending time in air conditioning and reducing skin exposure to the sun can reduce exposure to extreme heat, but little is known about the willingness and ability of women to adopt heat-health protective actions during pregnancy.</p> Methods <p>In summer and fall of 2024, a cross-sectional survey of 202 pregnant women 18 years and older living in Bexar County, Texas, was conducted. Participants were recruited from social service agencies, health clinics, and other facilities that provide pregnancy-related services. The self-administered survey was conducted online and in person in English and Spanish. The study examined the Health Belief Model’s dimensions of knowledge, risk perception, cue-to-action, self-efficacy, and socioeconomic factors on adoption of heat-health protective actions. Descriptive and bivariate statistics and logistic regressions were conducted.</p> Results <p>Drinking plenty of water to stay hydrated (<i>n</i> = 164, 81.2%) was the most frequently reported heat-health protective action adopted, followed by limiting time in the sun (<i>n</i> = 159, 80.7%), and spending time in air conditioning (<i>n</i> = 155, 77.9%). An 11-item heat-health protective actions scale had a mean of 6.84 (sd +/- 3.02). Statistically significant relationships were found between cue-to-action (Spearman’s rho=0.234, <i>p</i>&lt;.001), severity of extreme heat during pregnancy (Spearman’s rho=0.119, <i>p</i>=.049), extreme heat knowledge (Spearman’s rho=0.174, <i>p</i>=.008), and self-efficacy in transit (Spearman’s rho=0.143, <i>p</i>=.024) with the heat-health protective actions scale. In a logistic regression model, knowledge of excessive heat health risks had 19.2 greater odds (<i>p</i>=.022) of adopting above the mean number of heat-health protective actions. Cue-to-action in the form of daily weather checks had 5.2 (<i>p</i>=.053) greater odds of adopting seven or more heat-health protective actions. Difficulty in self-efficacy during transit had 2.8 greater odds (<i>p</i>=.010) of adopting seven or more heat-health protective actions.</p> Conclusions <p>The results indicate that the pregnant women who are knowledgeable about the effects of heat when not pregnant, actively seek weather information, and recognize their vulnerability to heat in locations such as work and in transit are more likely to engage in heat-health protective actions. Targeted messaging tailored to pregnancy is needed to encourage consistent and comprehensive use of heat-health protective actions.</p>