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Women constitute most of the global horticulture workforce, where pesticide use is prevalent. Protecting their health, particularly during pregnancy, is essential. However, knowledge about practices among pregnant employees that cause exposure to pesticides is limited. This study aims to identify such practices and assess the impact of pesticide-handling knowledge on exposure. A cross-sectional survey was conducted among 432 small-scale horticulture women workers in Tanzania from October 2022 to April 2023. The women were interviewed using a self-report questionnaire, with descriptive statistics, Pearson's chi-square tests, and T-tests used for data analysis. In total, 86% of participants worked in horticulture during pregnancy, with 47.5% continuing into the third trimester. Many engaged in weeding within 24 h of spraying (58.4%) and washing pesticide-contaminated clothes (51.7%). Most of the women (93.1%) had limited knowledge of pesticide handling, though some understood mixing (62.5%) and spraying (64.1%) instructions on labels. This study suggests that women working in horticulture are exposed to pesticides during pregnancy partly due to limited knowledge of safe pesticide handling. These exposures are largely shaped by the working conditions, which may place both pregnant women and their offspring at risk of hazardous pesticide exposure. Hence, there is a need for guidelines and policies towards protecting women working in agriculture.