Introduction: The erythrocyte sedimentation rate (ESR) is a widely used blood test to assess inflammation, but its utility in pregnancy is affected by physiological changes. During pregnancy, ESR levels can be influenced by increased plasma volume and fibrinogen levels. Objectives: This study investigated ESR levels and their relationship with hemoglobin in apparently healthy pregnant women. Materials and methods: The study was conducted as a cross-sectional study at SN Medical College, Agra, from August 2022 to March 2023. A convenient sampling method was used to select 881 pregnant women for the study. The dependent variable assessed was the ESR, and the independent variables were age, gestational age, and anemia. Demographic data and medical history were collected, and gestational age was determined based on the last menstrual period and confirmed through ultrasonography. Venous blood samples were collected for ESR measurement using the Westergren method. Frequency distribution analysis and statistical tests such as Chi-square and ANOVA were used for data analysis. Results: The mean age of the participants was 26.02 ± 4.12 years, and the mean ESR was 33.5 ± 20.5 mm/hr with a wide range (5.0–287.0). Most participants were in their second trimester (41.1%), gravida 1 was the most common (44.7%), while gravida 2 and gravida 3 accounted for 26.9% and 17.6%, respectively. Approximately, 70.4% of participants had moderate anemia, 26.2% had mild anemia, and 3.4% exhibited severe anemia. The comparison showed a significant difference in mean ESR between trimesters (p < 0.001). Hemoglobin negatively correlated with ESR (r = –0.108, p = 0.001). Severe anemia has significantly higher mean ESR (44.43 ± 20.45) (p = 0.008) than mild (34.17 ± 18.15), moderate (32.72 ± 20.21) anemia. Conclusion: Erythrocyte sedimentation rate levels tend to increase with advancing gestation during pregnancy. Anemia may lead to a mild increase in ESR. Healthcare professionals should interpret ESR results in pregnant women cautiously, considering physiological changes and utilizing more sensitive tests for assessing inflammation.