Background <p>This study aimed to evaluate the effect of integrating ChatGPT, a large language model–based tool, with standard physician consultations on preoperative anxiety and postoperative depression in women undergoing elective cesarean section (C/S).</p> Methods <p>A prospective, randomized study was conducted at two tertiary university hospitals between September 2023 and November 2024. Pregnant women scheduled for elective C/S were randomly assigned to either the intervention group (ChatGPT plus physician consultation) or the control group (physician consultation only). Anxiety and depression levels were assessed using the State-Trait Anxiety Inventory (STAI-I and STAI-II) and the Edinburgh Postnatal Depression Scale (EPDS). Postoperative pain was evaluated using a visual analog scale (VAS). ChatGPT responses were also independently assessed for medical accuracy. Statistical comparisons were made using Mann-Whitney U and chi-square tests.</p> Results <p>A total of 300 participants were included (150 per group). Baseline characteristics and psychological scores were comparable between groups. After the intervention, STAI-I scores were significantly lower in the ChatGPT group compared to the control group (median: 24 vs. 30, p = 0.012), indicating reduced preoperative anxiety. No significant differences were found in postpartum EPDS scores (median: 9 vs. 11, p = 0.797) or pain scores. ChatGPT responses were rated appropriate or accurate in over 90% of cases.</p> Conclusion <p>ChatGPT can serve as an effective supplementary tool to reduce preoperative anxiety in patients undergoing elective cesarean sections. By enabling direct patient engagement and delivering medically accurate information, it holds promise as a valuable adjunct to traditional obstetric care.</p> Trial registration <p>ISRCTN registry, ISRCTN55131007, registered on 06 March 2026, retrospectively registered.</p> Graphical Abstract <p></p>