OBJECTIVE: To investigate the knowledge, attitudes, and practices (KAP) of pregnant women regarding fetal growth restriction (FGR). METHODS: This cross-sectional study was conducted from December 2024 to January 2025 in Lishui City, Zhejiang Province, with pregnant women as study participants. A self-administered questionnaire was used to collect demographic information and assess KAP scores. RESULTS: A total of 381 participants were included in the study. The majority were <30 years old (55.12%), pregnant for >32 weeks (56.17%), and with their first pregnancy (48.56%). The mean scores for knowledge, attitudes, and practices were 11.08 ± 5.44 (out of 22, 50.36%), 30.33 ± 3.07 (out of 40, 75.83%), and 37.72 ± 2.99 (out of 40, 94.30%), respectively. Knowledge scores were positively correlated with attitude ( = 0.1269,  = 0.0132) and practice ( = 0.2838,  < 0.001) scores. The attitude scores were correlated with the practice scores ( = 0.2140,  < 0.001). Structural equation modeling (SEM) revealed that knowledge had direct influences on attitudes ( = 0.17,  < 0.001) and practices ( = 0.11,  = 0.004). Attitudes had a direct influence on practices ( = 0.61,  < 0.001). Knowledge had an indirect influence on practices through attitudes ( = 0.10,  < 0.001). CONCLUSION: Pregnant women exhibited limited knowledge but demonstrated favorable attitudes and proactive practices regarding FGR. Improving the knowledge about FGR through educational interventions could enhance both attitudes and practices.