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Background Antenatal anxiety and depression are prevalent conditions with significant risks to both maternal and infant health, contributing to preterm birth, low birth weight, and long-term developmental effects. Despite the recognized impact, limited research exists on these disorders in Bulgaria. This study assessed the prevalence of antenatal anxiety and depressive symptoms among pregnant women in Pleven Region and identified sociodemographic and psychosocial risk factors. Methods A cross-sectional survey was conducted from June to October 2024, involving 170 pregnant women in their third trimester at the University Hospital ‘St. Marina’ in Pleven, Bulgaria. Participants completed a self-administered questionnaire that included sociodemographic, behavioral, and psychosocial variables, along with the Antenatal Risk Questionnaire (ANRQ) to assess anxiety and depression. Results Nearly 50% of participants reported mild symptoms of anxiety or depression. Significant associations were found between these symptoms and lower educational attainment (p = 0.03), smoking during pregnancy (p = 0.01), and lack of partner support (p = 0.02). A history of adverse childhood experiences was linked to increased psychological distress (p = 0.01). Logistic regression revealed that higher educational attainment was the strongest protective factor (OR = 0.41, 95% CI: 0.24-0.71, p = 0.02). Conclusions These preliminary results indicate a high prevalence of antenatal anxiety and depression in Pleven Region, with significant predictors such as lower education and lack of partner support. The findings stress the need for integrated psychosocial screening during prenatal care, particularly for vulnerable groups. Further efforts should focus on national guidelines for perinatal mental health and early interventions in maternal care. Key messages • High prevalence of antenatal anxiety and depression in Pleven Region, linked to education and partner support. • Psychosocial screening and early interventions are crucial for improving maternal and infant health outcomes.