Background: Malaria in pregnancy (MiP) remains a leading, preventable cause of maternal anaemia, low birth weight and perinatal death in sub-Saharan Africa. Facility-level evidence on what women know, believe, and do to protect themselves is needed to guide health education. This study assessed knowledge, attitudes and preventive practices towards MiP among women of child-bearing age attending Arakale Comprehensive Health Centre, Akure, Ondo State, Nigeria, and identified the factors influencing them. Methods: We conducted a descriptive cross-sectional survey using a self-structured, interviewer-administered questionnaire. Respondents were selected by multi-stage sampling (age-stratified, then convenience sampling) from women attending antenatal clinics over two weeks. Of 271 questionnaires distributed (Cochran formula plus 10% non-response allowance), 250 were returned (response rate 92.3%). We analysed the data descriptively (frequencies and percentages) using SPSS version 27. Results: Most respondents were aged 25–44 years (68.0%). Overall, 76.0% (190/250) had good knowledge of MiP; 80.0% knew that mosquito bites transmit malaria, 92.0% that pregnant women are more vulnerable, and 98.0% that malaria can cause anaemia. Attitudes were favourable: 96.0% felt confident using recommended preventive measures and considered prescribed antimalarials safe. Practices were uneven: 80.0% attended antenatal care regularly and 88.0% sought care immediately when symptomatic, but only 20.0% reported regularly sleeping under an insecticide-treated net (ITN) and 68.0% took preventive medication as prescribed. Respondents identified health education (92.0%), advice from health workers (92.0%), level of education (88.0%), cultural beliefs (88.0%), family support (80.0%) and cost (76.0%) as influencing their practices. Conclusion: Good knowledge and positive attitudes did not translate into consistent ITN use, revealing a knowledge–practice gap. We recommend continuous, culturally sensitive health education during antenatal care; improved access to affordable ITNs and intermittent preventive treatment; and community involvement.