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Abstract: Objective: To assess the prevalence and risk factors for HIV, hepatitis B virus (HBV), and syphilis among pregnant women living on the Indian Ocean island of Mayotte. Methods: A cross-sectional survey was conducted among 671 pregnant women at 11 prenatal clinics on Mayotte between September 15, 2008, and September 27, 2009. Sociodemographic and behavioral characteristics were collected by interviewer-administered questionnaire. Blood samples were obtained for HIV, HBV, and syphilis testing. Risk factors were analyzed by exact logistic regression. Results: No prevalent case of HIV infection was detected among the study population. The prevalence of HBV surface antigen and active syphilis (defined as a positive test result by both rapid plasma reagin and Treponema pallidum hemagglutination assays) was 3.4% and 2.1%, respectively. A positive HBV surface antigen test was associated with being born in Comoros and having sex with a casual partner during the previous year. Lack of education and a history of sexually transmitted infections in the past 5years were associated with active syphilis. Conclusion: The continuing low prevalence of HIV and high prevalence of sexually transmitted infections among pregnant women on Mayotte confirmed the so-called “Indian Ocean paradox.” [Copyright &y& Elsevier]