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Pregnancy is a time of profound physical and psychological change, during which health behaviors can affect maternal and fetal outcomes. This study aimed to examine how body image and perceived media portrayals of pregnancy are associated with health behaviors among pregnant women. A cross-sectional survey was conducted with 921 participants across multiple Polish regions. Standardized instruments measured health-promoting behaviors, body esteem, and perceptions of media portrayals of pregnancy. Hierarchical regression analysis was used to identify clinical, psychological, and sociocultural predictors. Results showed that advancing gestational age was associated with a decline in health behaviors (B = -0.161; p < 0.001), while comorbidities predicted an increase (B = 2.871; p < 0.001). Negative media portrayals were linked to lower engagement (B = -2.938; p < 0.001), whereas positive portrayals and media underrepresentation correlated with increased health practices. Components of body esteem, especially physical condition (B = 0.812; p < 0.001), were the strongest predictors. The final model explained 87% of the variance in health behaviors (R² = 0.87; F = 433.54; p < 0.001). These findings underscore the need for holistic prenatal health promotion that incorporates body image, media perceptions, and psychosocial, clinical, and sociocultural factors to improve education and support outcomes.