The study assesses the levels of urinary pyrethroid pesticide (PYR) in women during early pregnancy. The factors associated with exposure are also determined. A total of 480 pregnant women from non-rural areas visiting hospital for prenatal examination during early pregnancy were enrolled. A self-designed, structured questionnaire was used to collect data on potential factors of PYR exposure. Urinary PYR metabolite levels were quantified using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The majority of urine samples (98.8%) contained one or more PYR metabolite, although only a few women self-reported pesticide exposure. Urinary 3-phenoxybenzoic acid (3PBA) levels were close to those reported in certain developed countries. However, the levels of 3-(2,2-dibromovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (DBCA) and 4-fluoro-3-phenoxybenzoic acid (4F3PBA) were higher than those reported in previous studies. Urinary PYR levels were positively associated with exposure to pesticides, consumption of bananas and oranges, the number of fruit types the women regularly ate, being multiparous, and cooked frequently. They were negatively associated with early pregnancy body mass index (BMI), unemployment, frequent intake of apples, and washing fruits and vegetables with soda or hot water. Pregnant women in non-rural areas were extensively exposed to low levels of PYRs. Dietary intake may be the primary pathway of exposure. The presented findings highlight the importance of using appropriate methods to reduce pesticide residues in food.