A low hemoglobin level indicates anemia, which has a variety of causes, including age, gender, smoking, poor nutrition, and lead exposure. Materials and method: This research design is observational, quantitative, and cross-sectional in nature. A study of 50 pregnant women. This study's variable was lead in the blood as determined by ICP-MS; hemoglobin was measured using the chyanmeth method, and cigarette smoke exposure was measured using a questionnaire. Result: 20 subjects out of a total of 50 had blood lead levels that were less than 5 g/dL. The Chi-square test and Fisher's exact test found no connection between iron consumption (p = 0.047) and lead concentration. In contrast, there is a significant association between lead level (p = 0.004) and tobacco exposure (p = 0.000) with anemia in pregnant women. Conclusions: Lead concentrations and exposure to tobacco both affect anemia in pregnant women. We advise monitoring high-risk women based on their social, occupational, environmental, and personal characteristics for serum lead levels during pregnancy. All governmental and private efforts must be made to limit lead exposure and consumption during pregnancy.