Khat is widely used in East African countries including Ethiopia. A growing body of evidence indicates that long-term khat use is associated with various health consequences. The aim of this study was to examine the magnitude and correlates of khat use in pregnant women.This study used a cross-sectional, face-to-face interview design that included 642 pregnant women receiving antenatal care services at primary care centers in Ethiopia. A series of chi-square tests and regression models were conducted to examine whether khat use status (i.e., 123 current khat users, 41 former khat users, and 478 non-users) was associated with socio-demographic, mental distress, and substance use measures.As compared with non-users, current and former khat users had higher levels of depressive symptoms and distress. Khat users minimized potential health risks associated with khat use. Social and motivational factors related to khat use were different between current and former khat users.Findings of this study suggest a substantial prevalence of khat use among pregnant women in Ethiopia and highlight the role of socio-demographic and cultural influences on khat use during pregnancy. Health care professionals in the region where khat is available are encouraged to ask their female patients about khat use and encourage them to refrain from use while they are pregnant. The positive link between khat and mental distress warrants further research focusing on biological, psychological, and social mechanisms of this relationship.