Background: Cervical cancer remains a leading cause of cancer-related deaths among women, particularly in developing countries like India and pregnancy offers a crucial opportunity for screening, as women are more likely to access healthcare during this period.

Objective: To determine the prevalence of abnormal cervical cytology in pregnant women and identify associated risk factors.

Methods: A cross-sectional study was conducted among 200 pregnant women attending antenatal OPD at Gauhati Medical College and Hospital from December 2023 to November 2024. Cervical smears were analyzed using the Bethesda System. Statistical analysis was performed using SPSS v20, with significance set at p<0.05.

Results: Among the participants, 71.9% had NILM, 24.6% had bacterial vaginosis, and 3.5% had candidiasis. A significant association was found between early age at coitarche and abnormal PAP findings (p=0.029). No significant associations were found with age, parity, contraceptive use and symptoms.

Conclusion: Integrating PAP smear screening into routine antenatal care is both feasible and effective. Early screening aids in detecting infections and potential cervical pathology, supporting better maternal health outcomes and highlighting the need for widespread implementation in resource-limited settings.