Micronutrient deficiencies, a global concern affecting vulnerable populations, including pregnant women, pose significant public health challenges. Specifically, micronutrient deficiencies in iron, vitamin A, iodine and folate have been of greatest public health concern among pregnant women. This study aimed to evaluate the co-occurrence of selected multiple micronutrient deficiencies among pregnant women attending Antenatal Care (ANC) in Mbeya, Tanzania. Employing a cross-sectional design, data were gathered from 420 pregnant women aged 15-49 years attending ANC in Mbeya Region. Semi-structured questionnaires captured socio-demographic data, and blood samples were collected for biomarkers assessment. The study used Stata 17.0 to analyze the data. Results revealed that six out of ten pregnant women exhibited at least one form of micronutrient deficiency, with 15.0% experiencing double deficiencies and 2.2% experiencing triple deficiencies. Iron Deficiency Anemia (IDA) was prevalent among 61.7% of anaemic pregnant women. Individual micronutrient deficiency rates were as follows: folate (21.7%), vitamin B12 (9.9%), iron (38.4%), vitamin A (9.8%), with a median Urinary Iodine Concentration (UIC) of 279.4μg/L. Pregnant women with anemia were more likely to have Multiple Micronutrient Deficiencies (MMD) compared to non-anemic counterparts (p-value <0.005). Additionally, those in the second trimester were at a higher risk of MMD than those in the first trimester (p-value <0.005). A higher wealth quantile appeared to protect against MMD (p-value <0.005). The study highlights the co-occurrence of MMD among pregnant women in Tanzania, indicates the necessity for an improved strategy to enhance multiple micronutrients intake through dietary diversity, MMS and fortified foods.