High Antenatal Psychosocial Risk Among Pregnant Women in Bulgaria: Evidence to Support Routine Mental-Health Screening

<b>Background:</b> Antenatal depression and anxiety contribute significantly to maternal morbidity and adverse pregnancy outcomes. However, structured screening and targeted interventions are largely absent from standard prenatal care in many Eastern European countries, including Bulgaria. This study examines the prevalence and psychosocial predictors of antenatal psychosocial risk using the validated Antenatal Risk Questionnaire-Revised (ANRQ-R) in a nationally underrepresented population. <b>Methods:</b> A cross-sectional survey was conducted among 216 third-trimester pregnant women in Bulgaria. Data on sociodemographic characteristics, health behaviours, and reproductive history were collected. Multivariate logistic regression identified predictors of elevated psychosocial risk. <b>Results:</b> A total of 65.7% of participants met the criteria for elevated psychosocial risk. Significant risk factors included passive smoking exposure during pregnancy (OR = 5.03, <i>p</i> < 0.001), physical activity prior to pregnancy (OR = 1.81, <i>p</i> = 0.004), and a family history of hereditary disease (OR = 42.67, <i>p</i> < 0.001). Protective factors were better self-rated current health (OR = 0.37, <i>p</i> = 0.004), the presence of chronic illness (OR = 0.42, <i>p</i> = 0.049), previous childbirth experience (OR = 0.11, <i>p</i> = 0.032), and residence in Northwestern Bulgaria (OR = 0.31, <i>p</i> = 0.028). Despite the high prevalence of psychosocial vulnerability, only 9.5% of affected women sought professional help. <b>Conclusions:</b> While our findings point to important unmet needs in antenatal mental health, further research is required before national screening policies can be implemented. Pilot programs, cultural validation of tools, and system-level readiness assessments should precede broad adoption.