Abstract Background: Maternal-fetal attachment (MFA) plays an important role in the maternal and fetal well-being. Despite the presence of consistent evidence about individual differences in the level of MFA, there is still a need to identify the most salient risk factors of MFA level especially among high risk pregnancy who are vulnerable to increase level of anxiety that can hinder an adequate mother–fetus attachment. Aim. This study aimed to compare maternal fetal attachment in low and high risk pregnancies and to identify the underlying factors which may affect maternal-fetal attachment among high risk pregnancy. Methodology. A descriptive cross-sectional design was used and conducted at the outpatient antenatal clinic at National Medical Institution, Damanhur City, Egypt for a convenient sample of 203 eligible pregnant women, the researchers used five tools to collect the necessary data; pregnant women basic data, Turkish version of the MFA Scale, Hobel's Prenatal Risk Score, Maternal Anxiety Scale & London questionnaire tool. Results. The findings of the present study portrayed a significant higher MFA among low risk mothers and a significant higher level of maternal anxiety was apparent among high risk. No significant differences was observed regarding MFA and pregnancy planning among both groups. Some personal and Obstetric variables affect the MFA level among high risk pregnant women. Conclusion. High risk pregnancy has lower level of MFA and higher level of anxiety with a remarkable obstetric predictors affecting their level of MFA. Recommendations: More attention should be given for high risk pregnant mothers through development and application of psychosocial nursing interventions program to decrease their anxiety level and improve maternal-fetal attachment.