Negative Pregnancy Experiences and Psychological Distress: Associations with Active Coping and Marital Satisfaction

Background and Objectives: High-risk pregnancy increases vulnerability to psychological distress, but protective mechanisms remain poorly understood. This study compared emotional distress and coping strategies between women with high- and low-risk pregnancies and investigated whether active coping and marital satisfaction moderated associations between negative pregnancy experiences, prenatal depression and perceived stress. Materials and Methods: A cross-sectional study was conducted among 195 pregnant women aged 18-51 years (M = 31.76, SD = 5.32), including 102 women with high-risk pregnancies and 93 women with low-risk pregnancies. Participants completed the EPDS, STAI, PSS-10, PRAS, PES, COPE, and CSI. Independent-samples t tests, correlation analyses, and moderation analyses were conducted. Results: Women with high-risk pregnancies reported significantly higher levels of prenatal depression (p = 0.032) and pregnancy-related anxiety (p < 0.001) than women with low-risk pregnancies. They also reported lower socio-emotional support (p = 0.036) and mental disengagement coping (p = 0.022). Negative pregnancy experiences were positively associated with state anxiety, pregnancy-related anxiety, prenatal depression, and perceived stress after controlling for pregnancy risk status (all p < 0.001). Maladaptive coping was generally associated with higher emotional distress, whereas adaptive coping, particularly positive reinterpretation and planning, was associated with lower levels of prenatal depression and anxiety. Active coping moderated the association between negative pregnancy experiences and perceived stress (β = -0.16, p = 0.016). Marital satisfaction moderated the association between prenatal depression and perceived stress among women with high-risk pregnancies (β = -0.21, p = 0.016). Conclusions: Active coping and marital satisfaction were associated with lower psychological distress and may represent potentially modifiable psychological resources for women experiencing high-risk pregnancies. Although the cross-sectional design precludes causal inferences, these findings highlight the potential value of integrating psychological screening, coping-focused interventions, and partner involvement into prenatal care, particularly for women with high-risk pregnancies.