A positive deviance inquiry was conducted in Al-Minia, Upper Egypt, to identify factors associated with achievement of good pregnancy outcomes despite limited resources. As compared with women with poor weight gain (n = 30), low-income women with weight gain greater than 1.5 kg per month in the second trimester of pregnancy (n = 11) were more likely to report multiple antenatal care contacts (80% versus 43%), increased rest during pregnancy (67% versus 7%), and more consumption of meat (33% versus 13%) and vegetables (82% versus 37%), and were less likely to report symptoms consistent with urinary tract infection (50% versus 90% with dysuria and 0% versus 57% with cloudy or reddish urine). Similar characteristics distinguished low-income women in a more economically advantaged community whose newborns weighed more than 3 kg (n = 18) as compared with mothers of smaller newborns (n = 18). These characteristics were similar to those identified in the National Research Center's Al-Minia birthweight study. The positive deviance inquiry is an affordable, participatory step to identify accessible individuals, behaviors, and conditions for improved perinatal health.