Background <p>Pregnant women’s emotional well-being is a major determinant of maternal and pregnancy outcomes. This study aimed to estimate the prevalence of pregnant women’s perceived unhappiness with their current pregnancy, and to examine the reasons and factors associated with such feelings in Quelimane district, Central Mozambique.</p> Methods <p>A population-based pregnancy surveillance study was conducted during 2023–2024. Data included pregnant women’s perceived status of unhappiness with their current pregnancy at realization, reasons for such feelings, and perceived reactions of their sexual partners. Variables associated with women’s unhappiness were investigated within a couple-centered conceptual framework that views pregnancy-related unhappiness as the result of interacting socio-demographic, reproductive, and partner-level factors; using descriptive statistics and multivariate logistic regression (three sequentially adjusted models).</p> Results <p>Among the 1546 participating women, 24.5% referred being unhappy with their pregnancy, and this was higher among adolescents (42.2%), in daughters/grand-daughters/daughters-sisters-in-law (33.5%), residing in larger households (29.7%), un-married women (36.6%), first trimester of gestation (37.7%), without couple’s communication about childbirth (48.9%), and with unhappy partner (74.5%). The leading reasons for unhappiness were unplanned pregnancy (30.2%), unwanted/undesired pregnancy (26.5%), and fear of consequences (17.7%). In the multivariate logistic regression analysis, the associations of socio-demographic (first model) and reproductive (second model) variables with unhappiness were progressively attenuated as the models were being fitted. In the fully adjusted model (third model), women’s age and gestational age maintained strong association with unhappiness, with adolescents and older women showing higher odds of unhappiness compared to middle-aged adults (OR = 2.18, 95% CI:1.43–3.32) and (OR = 2.21, 95% CI:1.25–3.93), respectively; and women interviewed in the first and third trimester being more likely to be unhappy than those in the second trimester (OR = 2.19, 95% CI:1.10–4.37) and (OR = 1.51, 95% CI:1.08–2.11), respectively. However, partner-related variables emerged as strongly associated with maternal unhappiness, with partner’s unhappiness with pregnancy showing ORs of 8.23 (95% CI:5.04–13.43), lack of couple’s communication (OR = 2.23, 95% CI:1.34–3.74), and partner’s pregnancy intendedness showing ORs of 1.73 (95% CI:1.12–2.65).</p> Conclusions <p>Nearly one in four women in Quelimane reported being unhappy with their pregnancy, and unhappiness was particularly frequent among adolescents, non-married, women in first gestational age, those without couple’s communication, and with unhappy partners. While women’s socio-demographic and reproductive factors contributed to unhappiness, partner’s emotional response and couple communication were the most influential factors. These findings highlight the importance of couple-centered approaches in maternal health research and interventions, particularly for adolescents and other vulnerable groups.</p>