Perception and knowledge of risk factors for pregnancy influence health behaviors during pregnancy and childbirth. We used a descriptive qualitative study to examine the perception and knowledge of risk factors in pregnancy and childbirth in low-income urban women in Ghana. Over the course of three-months, 12 focus group discussions and six individual interviews were conducted with 90 participants selected from six communities in the study area. Data were analyzed using inductive-thematic content analysis. Findings revealed that participants had knowledge of some risk factors, although some had superstitious beliefs. Participants viewed pregnancy as an exciting and unique experience, but also challenging, with a host of medical and psychological risks. Pre-existing medical conditions (e.g., diabetes), lack of physical activity, poverty, poor nutrition, and lack of social support were identified as conditions that could lead to negative pregnancy outcomes. Superstitious beliefs such as exposure to “evil eye” during pregnancy, as well as curses and spells, were also identified as risk factors for pregnancy complications. This research has implications for policies and programs to improve pregnancy outcomes for low-income women in Ghana. Thus, we recommend social and economic support programs as well as health education to change misperceptions about pregnancy risk and to support other efforts being made to improve maternal health outcomes.