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Background: Lumbopelvic pain (LBP) is a prevalent condition during pregnancy, affecting a significant proportion of pregnant women. It arises from hormonal, biomechanical, and postural changes, often exacerbating discomfort and impairing quality of life. This study aimed to evaluate the effects of targeted motor control interventions focusing on sternal alignment on spinal alignment, pain, and muscle activity in pregnant women at risk of preterm birth. Methods: This pre–post quasi-experimental study included 32 pregnant women at 28–32 weeks of gestation, who were hospitalized due to the risk of preterm birth. Inclusion criteria required participants to have LBP lasting at least two weeks and the ability to walk and stand for 40 min. The intervention involved targeted motor control exercises designed to optimize sternal and sacral alignment. Spinal alignment, pain intensity, and muscle activity were measured pre- and post-intervention using the DIERS formetric system, numerical rating scale (NRS), and electromyography (EMG), respectively. Data were analyzed using Wilcoxon signed-rank tests. Results: Significant improvements were observed in spinal alignment parameters, including reductions in the sternal angle, sacral angle, cervical and lumbar lordosis depths, thoracic kyphosis angle, and pelvic tilt (p < 0.05). Pain intensity decreased significantly from a mean NRS score of 5.77 ± 1.42 in the relaxed posture to 2.54 ± 0.71 in the corrected posture (p < 0.05). Muscle activity of the rhomboid muscles increased in the corrected posture, correlating with improved thoracic kyphosis, while activity of the serratus anterior muscle showed reductions (p < 0.05). Conclusions: Targeted motor control focusing on sternal alignment effectively improved spinal alignment and reduced pain in pregnant women at risk of preterm birth with LBP. The intervention offers a safe, non-invasive, and practical approach to managing pregnancy-related musculoskeletal challenges. Future research should validate these findings in diverse populations and explore long-term effects and broader clinical applications. [ABSTRACT FROM AUTHOR]