Background <p>While anemia and psychological distress (depression and anxiety) are independent risk factors for pregnancy complications, the impact of their co-occurrence—particularly on specific outcomes like delivery mode and neonatal well-being—is not well established.</p> Methods <p>This retrospective cohort study included 155 pregnant women from the Babol University of Medical Sciences’ Pregnancy Mental Health Registry System. Hemoglobin levels were measured at the time of admission for delivery to assess anemia. Anxiety and depression were evaluated using the Brief Symptom Inventory-18 (BSI-18) questionnaire at two time points: during labor and 4–6 weeks postpartum. Statistical analyses were performed using t-test, chi-square test, correlation coefficient, and logistic regression in SPSS V22, with a significance level of <i>p</i> &lt; 0.05.</p> Results <p>Approximately 34.8% of participants were diagnosed with anemia. Anemia was significantly associated with postpartum depression and anxiety. Women with anemia had higher odds of postpartum depression (OR = 3.21, 95% CI [1.45, 7.11]) and anxiety (OR = 2.89, 95% CI [1.32, 6.33]) than those without anemia. Anemia was linked to a higher likelihood of cesarean delivery (OR = 2.72, 95% CI [1.25, 5.89], <i>p</i> = 0.011). Maternal anxiety was associated with both cesarean delivery (OR = 4.26, 95% CI [1.89, 9.87], <i>p</i> = 0.001) and lower 5-minute neonatal viability assessment scores (β = -0.36, <i>p</i> = 0.022). No significant associations were observed between anemia, depression, or anxiety and neonatal birth weight or length.</p> Conclusion <p>Anemia is a significant risk factor for postpartum depression and anxiety. The co-occurrence of anemia and anxiety was particularly associated with increased risk of cesarean delivery and poorer neonatal outcomes as measured by neonatal viability assessment. Integrated screening and management of both anemia and mental health disorders during pregnancy are recommended to improve maternal and neonatal outcomes.</p>