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 in Tanzania from October 2022 to April 2023. The women were interviewed using a self-reported questionnaire, with descriptive statistics, Pearson’s chi-square, 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 hours of spraying (57.2%) and washing pesticide-contaminated clothes (51.6%). Most 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 engage in activities that expose them to pesticides during pregnancy and have low knowledge of pesticide handling. Such practices expose pregnant women and their offspring to hazardous pesticides. There is a need for deliberate efforts towards protecting women in dangerous workplaces such as agriculture.