BackgroundAreca nut is the fourth most commonly used substance worldwide after nicotine, alcohol, and caffeine. Women in many countries use it in cultural and religious ceremonies. The use of areca nut is harmful to health; but when women consume it during pregnancy, it exerts several harmful effects on the fetus. This paper examines the prevalence and determinants of areca nut use among pregnant women in India.MethodsData from the Global Adult Tobacco Survey-2, India, are used for analysis (N = 1403 pregnant women). Multiple classification analysis and multivariate logistic regression model were applied to estimate the effect of various determinates.ResultsAbout 16% pregnant women used areca nut in any form in India. Areca nut use with (24%) and without (13%) tobacco was higher among scheduled tribes. Region, caste, religion, place of residence, educational attainment, occupation, and economic status are found to be important determinants of areca nut use.ConclusionMore specific programs which can effectively reduce the use of areca nut among pregnant women should be adopted. Programs related to prevention of areca nut use should be expanded effectively through health awareness interventions during pregnancy, including media messages, and involvement of frontline health workers, especially focusing on the socio-economically backward groups.