Objective To evaluate current knowledge and practice among pregnant women about the use of car restraint systems during pregnancy. Design A structured questionnaire. Setting District hospital antenatal clinic. Participants Two hundred pregnant women attending for their routine mid-pregnancy anomaly scan. Main outcome measures The women were asked about seatbelt and airbag usage, source of information about restraint systems and the legal requirements and recommendations regarding car safety systems. Results One hundred fifty-nine women (80%) completed the questionnaire. Ninety-eight percent wore seatbelts in the front, 68% wore seatbelts in the back of a car, 48% correctly identified where to place the seatbelt and 37% had received information on seatbelt use while pregnant. The latter were more likely to correctly position their restraints than those who had received no information (P= 0.03). Thirty-nine percent had an airbag system fitted and one woman had de-activated it. Fifty-eight percent were aware seatbelt use was a legal requirement for driver and passengers when fitted. Conclusions Many pregnant women are ignorant of the correct usage of seatbelts, their positioning and legal requirements. This puts their own wellbeing, and that of the fetus, at risk. Women should receive written instructions and advice from well informed health professionals and be encouraged always to wear a correctly positioned seatbelt. Education increases compliance and correct usage.