Purpose <p>This study was conducted to compare psychosocial health and anxiety levels of high-risk and healthy pregnant women.</p> Methods <p>The study is a observational case-control type and was implemented in Türkiye between September 1, 2022 and July 31, 2023. The study sample consisted of pregnant women diagnosed with high-risk pregnancy (<i>n</i> = 255) and healthy pregnant women (<i>n</i> = 275). The Pregnancy Psychosocial Health Assessment Scale (PPHAS) and the Pregnancy-related Anxiety Scale (PrAS) were used to assess the psychosocial health and anxiety levels of the participants in the study.</p> Results <p>It was determined that those with high-risk pregnancies had higher total PrAS scores (<i>p</i> &lt; 0.001, effect size = 1.551) and lower total PPHAS scores (<i>p</i> &lt; 0.001, effect size = 0.514) compared to healthy pregnant women. In the study, it was determined that as the PPHAS score decreased in both the high-risk and healthy pregnant groups, the PrAS score increased. As a result of the linear regression analysis, it was determined that high-risk pregnancy (<i>p</i> &lt; 0.001), experiencing a stressful event during pregnancy (<i>p</i> &lt; 0.001), and regular antenatal control (<i>p</i> = 0.005) affected psychosocial health during pregnancy. Moreover, it was found that high-risk pregnancy (<i>p</i> &lt; 0.001), regular antenatal control (<i>p</i> = 0.014), relationship status with the spouse (<i>p</i> = 0.013), and psychosocial health level during pregnancy (<i>p</i> &lt; 0.001) affected the anxiety level during pregnancy.</p> Conclusion <p>According to the results of this study, high-risk pregnant women are at risk in terms of psychosocial health and anxiety. It is recommended that healthcare professionals assess women with high-risk pregnancies for psychosocial health and anxiety. Midwives should use assessment tools, provide counseling, and provide holistic care to protect the psychosocial health of high-risk pregnant women and to diagnose psychological distress at an early stage.</p>