This study aims to explore pregnant women’s attitudes to COVID-19 vaccination and determinants of vaccine acceptance. We conducted a cross-sectional study among pregnant women attending PHC clinics and hospitals in the West-bank of Palestine. We used an interviewer-administered questionnaire based on Health Belief Model. The study’s primary outcome was COVID-19 vaccination acceptance. We used the Chi-square test to compare those who accepted the vaccine versus those who refused it and conducted binary logistic regression to explore independent determinants of vaccination acceptance. Among the 728 pregnant women who took part in the study, 20.7 percent showed positive attitudes (acceptance) toward COVID-19 vaccination. Employment (aOR 4.0; 95 percent CI: 2.2–7.3), a history of COVID-19 (aOR 1.9; 95 percent CI: 1.2–3.1), and having a relative who died from COVID-19 (aOR 2.3; 95 percent CI: 1.2–4.7) increased the likelihood of vaccine acceptance, as did vaccine perceived effectiveness (aOR 1.9; 95 percent CI: 1.2–3.2) and perceived protection from severe disease (aOR 2.0; 95 percent CI: 1.2–3.5). On the other hand, perceived limited access (aOR 0.540; 95 percent CI: 0.31–0.87) and perceived harm to the baby (aOR 0.346; 95 percent CI 0.22–0.54) remained the main barriers toward vaccine acceptance. In conclusion, pregnant women’s acceptance of the COVID-19 vaccine is unsatisfactory. Concerns about its effect on unborn babies were major barriers to vaccination.