Psychosocial Perceptions and Health Behaviors Related to Lifestyle During Pregnancy: A Cross-Sectional Study in a Local Community of Albania

<b>Background:</b> Maternal health behaviors during pregnancy are crucial for maternal and fetal outcomes. While global research has explored that demographic, clinical, and psychosocial determinants significantly influence these behaviors, evidence from low- and middle-income countries (LMICs), including Albania, remains limited. This study aims to evaluate psychosocial perceptions and health behaviors related to lifestyle among pregnant women in a local Albanian community in order to identify which are higher risk subgroups that need targeted and tailored antenatal care interventions. <b>Methods:</b> This multicenter cross-sectional study included 200 pregnant women attending antenatal clinics from May to August 2024 in Vlora city, Albania. Participants were selected using consecutive sampling based on inclusion criteria. Data were collected through a validated questionnaire composed of five sections: demographic/obstetric data; maternal health behaviors; dietary diversity; physical activity, perceived stress; and social support. Clinical and anthropometric measurements were assessed by trained health professionals during antenatal visits. SPSS version 23.0 and binary logistic regression with <i>p</i>-value ≤ 0.05 statistically significant were used for data analysis. <b>Results:</b> Mean age was 28.3 ± 6.4 years, 71% employed and 83.5% urban residents. Key unhealthy behaviors included tobacco use (25.5%), alcohol consumption (10.5%), exposure to toxins (15%), and low dietary diversity (32%). We found significant correlations between low dietary diversity and rural residence (Adj OR = 2.48), hypertension (Adj OR = 6.88), and overweight/obesity (Adj OR = 2.33). Tobacco use was associated with unemployment and alcohol use with unemployment and hypertension variables. Low/moderate social support and high perceived stress were significantly related with multiple unhealthy behaviors, such as low dietary diversity, inadequate physical activity and antenatal care. <b>Conclusions:</b> Unhealthy nutritional behaviors, tobacco and alcohol use and low physical activity are more prevalent risk factors among pregnant women in Vlora city. Priority should be given to vulnerable groups, including rural residents, pregnant women with low social support, high perceived stress and those with hypertension and obesity. Interventions that integrate psychosocial support and health education into antenatal care services are urgently needed to enhance pregnancy outcomes in Albanian communities.