Background <p>Globally, malaria remains a critical public health challenge, particularly in sub-Saharan Africa. Pregnant mothers are at a relatively higher risk of severe malaria than their non-pregnant counterparts due to natural immune suppression. In Ghana, the prevalence of malaria during pregnancy poses significant risks to maternal and fetal health. The primary aim of this study was to determine the factors associated with malaria in pregnancy among women attending ANC clinics in the Kwadaso Municipal, Ghana.</p> Method <p>This study employed a cross-sectional design to gather quantitative data from 405 pregnant women using a multistage sampling method. Data were collected through structured questionnaires administered. Descriptive and inferential statistics, including frequency tables, percentages, and regression analysis using Stata 17, were utilized for data analysis.</p> Results <p>Out of the 405 participants, 201 (49.6%) tested positive for malaria, while the knowledge level of malaria among pregnant women was 16.5%. Bivariate logistic regression was conducted to determine the factors influencing malaria among pregnant women. The results showed that pregnant women aged 17 to 25&#xa0;years are 5.41 times more likely to have high malaria prevalence compared to 40 to 51 age group (cOR = 5.41, 95% CI [2.20–6.83], <i>p</i> = 0.015). Pregnant women who do not use insecticide-treated bed nets regularly users are 10.3 times more likely to have high malaria compared to users (cOR = 10.3, 95% CI [4.05–11.02], <i>p</i> &lt; 0.001). Multivarite logistic regression also showed that Women earning between 100 to 500 cedis are 7.0 times more likely to have malaria compared to those earning 3000 cedis or more (aOR = 7.0, 95% CI [3.23–8.74], <i>p</i> = 0.003). Women who do not regularly use insecticide-treated bed nets are 15.0 times more likely to experience high malaria prevalence compared to those who do use them (aOR = 15.0, 95% CI [7.03–16.09], <i>p</i> &lt; 0.001), Lack of mosquito nets significantly increases the likelihood of 9.53 times high malaria prevalence (aOR = 9.53, 95% CI [4.07–10.95], <i>p</i> = 0.003). Pregnant women with Junior High School (JHS) education are 3.50 times more likely to have high malaria compared to those with no formal education (aOR = 3.50, 95% CI [1.32–4.78], <i>p</i> = 0.002).</p> Conclusion <p>This study highlights the significant burden of malaria among pregnant women in Kwadaso Municipal. Factors such as age, education levels, and socioeconomic status were identified as key determinants of malaria diagnosis. Additionally, environmental and preventive factors, including insufficient use of insecticide-treated bed nets and proximity to stagnant water, contributed to the likelihood of malaria. The study suggests that the Ghana Health Service and Ministry of Health should improve access to insecticide-treated bed nets, enhance malaria awareness, and integrate regular malaria screening into antenatal care.</p>