This study examined the relationships among prenatal distress, negative pregnancy perception, fetal health locus of control, and anxiety and depression in women with high-risk pregnancies. A descriptive correlational design was used. The study was conducted between January and May 2025 and included 327 high-risk pregnant women hospitalized in the perinatology unit of a tertiary hospital in Central Anatolia, Turkey. Data were collected using standardized self-report instruments. Elevated anxiety symptoms were observed in 43.7% of participants, and 57.8% reported elevated depressive symptoms. Prenatal distress was significantly associated with perceived income, education level, pregnancy intention, diagnostic knowledge, social support, fear during pregnancy, and anxiety and depressive symptoms, with psychological symptoms emerging as the strongest predictors in a hierarchical regression analysis. Negative pregnancy perception was significantly related to perceived income, pregnancy intention, social support, and anxiety and depressive symptoms and was independently predicted by greater psychological symptoms, unintended pregnancy, lower income, and inadequate social support. An internal health locus of control was associated with education level, pre-pregnancy chronic disease status, and diagnostic knowledge, whereas chance-oriented beliefs were related primarily to chronic disease status. A powerful others health locus of control was significantly associated with education level and adequacy of diagnostic information. Overall, the findings indicate that prenatal distress and negative pregnancy perception in high-risk pregnancies are closely linked to psychological symptoms and selected sociodemographic and obstetric factors. These results emphasize the importance of routine mental health screening, targeted patient education, and integrated psychosocial support to promote adaptive pregnancy perceptions and health-related control beliefs in high-risk pregnancy care.