The study determined the factors influencing anemia among pregnant women in the Twifo Atti-Morkwa District of Ghana. This study employed a hospital-based cross-sectional study design to assess the risk factors for anemia among pregnant women. About 430 pregnant women attending antenatal care services in all health facilities in the Twifo Atti-Morkwa district were used as respondents for the study. Data were collected quantitatively using a structured questionnaire. The questionnaire was administered using a face-to-face interview process. The data were analyzed using STATA version 15 (StataCorp, College Station, Texas 77845, USA). Pearson’s chi-square and binary logistic regression were used to find the variables significantly associated with anemia in pregnancy at a p-value of 0.05. The findings showed the respondents were within the age range of 15 to 45 years, with a mean age of 26.36 years. Only 49.07% of them had visited ANC at least 4 times. Additionally, 50.93% of them started ANC attendance in the first trimester of their pregnancy. The majority of them (89.77%) attended ANC regularly. Most of them indicated that they took routine ANC drugs, and among them, 91.75% took iron supplements, 87.63% took folic acid, and 49.74% took Sulfadoxine-pyrimethamine, and 66.75% took multivitamins. Despite the regular ANC attendance, high intake of iron and folic acid supplements, and high utilization of ITN, the prevalence of anemia in pregnancy at 36 weeks of gestation in the Twifo Atti-Morkwa district was high. Anemia at 36 weeks of gestation was significantly associated with factors such as the number of ANC visits, gravidity, gestational age at the start of ANC, malaria infection, and intake of food supplements. To address the burden of anemia in pregnancy in the district, it is vital to note that supplements alone are not adequate. There, therefore, is a need for intensive education on other strategies such as deworming, nutrition, and adherence to Sulfadoxine-pyrimethamine to improve general health in women before and during pregnancy.