Objectives: To assess the factors associated with utilization of genetic counseling services among pregnant Israeli Arab women. Methods: A case-control study was conducted among 414 pregnant Arab women who were referred by a family physician or a perinatologist to genetic counseling services between 2008 and 2011. Data was collected using interviews, with both groups 'users' and 'non-users' of genetic counseling, based on a structured questionnaire including demographic, socio-economic, medical and cultural variables. Results: In multivariate analysis, factors affecting women's utilization of genetic counseling service were high income level (OR 3.44, 95%CI 1.8-6.5, p<0.001), high service accessibility (OR 0.75, 95%CI 0.67-0.84, p=0.001), more positive attitude toward genetic counseling (OR 0.43, 95%CI 0.27-0.67, p=0.012) and lower religiosity level (OR 1.40, 95%CI 0.94-2.09, p=0.04). However, when we examined the following variable: pregnant woman's age, woman's education, consanguinity and pregnancy' age, knowledge level and the perspective toward abortion, no significant differences were found between the users and non-users groups. Conclusions: The underutilization of genetic counseling services among pregnant Israeli Arab women was associated with the following: lower income level, attitude toward genetic counseling, accessibility to service and religiosity. Thus, it is advisable to expand genetic counseling service within this community.