Background <p>Perceived partner support during pregnancy influences maternal mental health and antenatal care utilization. However, limited evidence exists regarding how different dimensions of partner support relate to pregnancy-related anxiety and fear of childbirth, and the mechanisms underlying these associations. This study examined the associations between perceived partner support, pregnancy-related anxiety, antenatal care utilization, and fear of childbirth, and explored the mediating role of pregnancy-related anxiety.</p> Methods <p>A total of 331 pregnant women were included in this cross-sectional study. Data were collected using the Personal Information Form, the Perceived Partner Support Scale, the Pregnancy-Related Anxiety Scale, and the Wijma Delivery Expectancy/Experience Questionnaire. Binary logistic regression analysis was conducted to identify the determinants of regular antenatal care utilization. Hierarchical linear regression analysis was conducted to examine the determinants of pregnancy-related anxiety. After controlling for sociodemographic and relational variables, a mediation analysis was conducted using Hayes’ PROCESS macro (Model 4) with 5,000 bootstrap samples.</p> Results <p>Financial support was a significant negative predictor of pregnancy-related anxiety (B = − 2.19, <i>p</i> &lt; 0.001), while pregnancy-related anxiety was positively associated with fear of childbirth (B = 0.88, <i>p</i> &lt; 0.001). Financial support also had a significant direct effect on fear of childbirth (B = − 1.47, <i>p</i> = 0.002). The mediation analysis showed that pregnancy-related anxiety partially mediated the relationship between financial support and fear of childbirth (indirect effect = − 1.93, 95%CI [− 2.73, − 1.27]). Additionally, the logistic regression analysis indicated that financial support significantly increased the likelihood of regular antenatal care utilization (OR = 1.66, <i>p</i> = 0.024), while higher pregnancy-related anxiety was associated with a decreased likelihood of regular antenatal care utilization (OR = 0.91, <i>p</i> = 0.014). All models were statistically significant (<i>p</i> &lt; 0.001).</p> Conclusion <p>Partner support during pregnancy plays a multifaceted role in maternal psychological well-being and health-related behaviors. Partners’ financial support emerged as a key protective factor associated with lower pregnancy-related anxiety, reduced fear of childbirth, and greater utilization of antenatal care. Pregnancy-related anxiety serves as an important mediating mechanism. These findings underscore the importance of family-centered antenatal care approaches that actively involve partners and address both psychosocial and structural support needs.</p>