Introduction: Against the challenging socio-political backdrop of the country, this research examines the periodontal health of pregnant women in Sri Lanka. Methods: This analytical cross-sectional study was conducted among 576 pregnant women, attending community Antenatal Clinics in a selected Medical Officer of Health area, in Sri Lanka. A two-stage cluster sampling method with a probability proportionate to size technique was used to select the clinics. Systematic sampling was used to recruit pregnant women from each clinic. An interviewer-administered questionnaire and oral health examination form were used for data collection. Results: Over 60% exhibited poor oral hygiene. Moderate to severe gingivitis was seen among 23.3%. Approximately 67% of participants demonstrated poor knowledge about periodontal diseases. About 67% of the study participants were unemployed and 32.47% had a monthly income of less than 40,000 rupees. Regression analysis identified the trimester of pregnancy, socioeconomic indicators, frequency of dental visits, recent full mouth scaling, and knowledge about periodontal diseases as significant predictors of oral hygiene status. Age, trimester, brushing frequency, recent full mouth scaling, and knowledge about periodontal diseases predicted the gingival status. Participants with a lower socioeconomic status demonstrated poorer oral hygiene and gingival health. Conclusion: There was suboptimal oral hygiene and gingival health coupled with limited access to dental care and inadequate knowledge about periodontal health that demands urgent interventions. The high prevalence of unemployment combined with the association between low socioeconomic indicators and poor periodontal health outcomes, underscores the importance of empowering young women through education and employment.