Background <p>Pregnancy-Related Anxiety (PRA) is a significant yet often overlooked mental health issue. The absence of validated tools for assessing PRA in multilingual contexts hinders the provision of equitable care. This study aimed to fill this gap by culturally adapting and validating the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2) for Sinhala and Tamil populations.</p> Methods <p>We conducted a cross-sectional study involving 200 pregnant women, with 100 participants in each language group. These women attended antenatal clinics at two tertiary care hospitals in the Western Province of Sri Lanka between 2024 and 2025. Participants were selected using convenience sampling, excluding those with diagnosed psychiatric disorders. The PRAQ-R2 was translated following WHO guidelines, including forward and back-translation, expert panel review by clinical psychologists, obstetricians, and midwives, and cognitive pretesting. We used exploratory factor analysis to validate the tool. Internal consistency was evaluated using Cronbach’s alpha.</p> Results <p>The exploratory factor analysis of both translated versions confirmed the original three-factor structure of the PRAQ-R2, comprising fear of giving birth, worries about bearing a child with a disability, and concerns about physical appearance. All items showed acceptable factor loadings. Internal consistency was good for both versions. The Sinhala version demonstrated subscale Cronbach’s alpha values of 0.813, 0.922, and 0.733, with an overall alpha of 0.86, while the Tamil version showed corresponding values of 0.705, 0.879, and 0.733, with an overall alpha of 0.81.</p> Conclusion <p>Sinhala and Tamil PRAQ-R2 are valid and reliable tools for assessing PRA in Sri Lanka.</p>