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Pregnancy-related anxiety appears to be more strongly associated with adverse outcomes in obstetrics and mental health than commonly assessed general anxiety. Support for anxiety should start in the early stages of pregnancy; however, the associated factors for pregnancy-related anxiety in early pregnancy remain unclear. This study aimed to clarify the associated factors for pregnancy-related anxiety in the early stages of pregnancy. We conducted a cross-sectional study among 183 pregnant Japanese women who were ≥ 18 years, pregnant with one baby, and before 15 weeks of gestation from four facilities in Japan. Pregnancy-related anxiety was assessed using the Japanese version of the Pregnancy-Related Anxiety Questionnaire-Revised-2. Multiple linear regression analysis was performed to identify factors associated with total and subscale of pregnancy-related anxiety, including obstetric, individual, and environmental factors. The model that included all factors accounted for 24% of the variance in total pregnancy-related anxiety score. Significant associated factors included previous deliveries (β = -0.27), general anxiety (β = 0.26), a history of smoking (β = 0.19), and pre-pregnancy body mass index (β = 0.17). Lifetime history of abuse and/or domestic violence (β = 0.20) and current daily hassles (β = 0.20) were also independently associated with higher anxiety levels. Subscale analysis revealed a distinct pattern: while traditional obstetric and individual factors were associated with fear of childbirth and worries about bearing a handicapped child, environmental stressors were specifically associated with concern about own appearance. This study demonstrated that pregnancy-related anxiety is uniquely shaped by the additive effects of lifetime trauma and current environmental stress. While traditional clinical backgrounds help identify fears regarding childbirth and infant health, they are insufficient to capture self-image concerns. In addition to identifying a history of abuse or high daily stress, we recommend direct measurements of pregnancy-related anxiety to provide tailored counseling that addresses these often-overlooked psychological vulnerabilities in early pregnancy.