Abstract Objective: To describe the nutritional intake and status of pregnant women in Bloemfontein and compare across different household food security categories. Design: Cross-sectional. Setting: Pelonomi Tertiary Hospital. Participants: 427 pregnant women were interviewed using a standard questionnaire and a quantitative FFQ to collect socio-demographic, HIV status, household food security, supplement and dietary intake data. Weight and height were measured using standard anthropometric techniques and capillary blood taken by finger-prick for anaemia, Fe and inflammation status assessment. Results: 26·7 % of participants were food secure, while 11·5 %, 32·1 % and 29·5 % experienced mild, moderate and severe food insecurity, respectively. 54·5 %, 41·7 % and 31·1 % were obese, anaemic and Fe deficient. Median energy intake was 8808 (6978–9223) KJ/d, with no significant differences between the food security groups ( P = 0·517). Based on the dietary reference intakes, 98·1 % met the estimated average requirement (EAR) for carbohydrates, but the majority had sub-optimal intake of protein (58·3 %), fibre (60·9 %), pantothenic acid (67·0 %), vitamins C (65·6 %), D (68·4 %), E (59·0 %) and K (61·8 %), potassium (99·8 %), dietary Ca (95·8 %) and Fe (80·8 %). Compared with the moderately and severely food-insecure counterparts, food-secure participants had a higher intake of animal protein ( P < 0·001), total fat ( P = 0·014), monounsaturated fat ( P = 0·002), vitamins B 12 ( P = 0·014), C ( P < 0·001) and D ( P = 0·003) and dietary Ca ( P = 0·001). Dietary folate intake was below the EAR in 69·9 %, but was higher among severely food-insecure participants (463·94 (327·39, 609·71) µg than food secure (378·49 (265·99, 496·15) µg, P = 0·007)). Conclusion: The findings show widespread inadequate nutrient intake among pregnant women in Bloemfontein, with food-insecure women showing significantly lower intake of specific nutrients.