This study evaluates the impact of psychosomatic interventions on the immune system and microbiome composition of pregnant women diagnosed with gestational hypertension. A case-control study on 200 pregnant women diagnosed with gestational hypertension was conducted between June 2021 and December 2024. The control group (n  100) included pregnant women diagnosed with gestational hypertension and under only pharmacological treatment with antihypertensive drugs such as labetalol. The case group (n  100) received standard care for hypertensive disorders in pregnancy like control group, but in addition to it, we incorporated evidence based psychosomatic medicine to this group. Psychosomatic medicine included stress management, relaxation techniques, and counseling for the study group. Primary outcomes included blood pressure levels, psychological state (SAS and SDS scores), mode of delivery, incidence of complications, neonatal outcomes, patient satisfaction, reductions in inflammatory cytokines (e.g., IL-6, TNF-alpha), and improvements in microbiome diversity. Psychosomatic intervention led to a significant increase in microbiome diversity (Shannon Index, P < 0.05). Beta-diversity analysis revealed a distinct separation in microbial community composition between the study and control groups (P  0.02). The case group also showed a reduction in proinflammatory cytokines, IL-6 decreased from 40.0 to 28.0 pg mL-1 (P  0.008) and TNF-alpha from 25.0 to 18.0 pg mL-1 (P  0.004). The case group demonstrated significant improvements in systolic (P  0.020) and diastolic (P  0.003) blood pressures, psychological well-being (SAS, P  0.006; SDS: P  0.026), and delivery outcomes (P  0.032). Complications were significantly lower in the case group (P  0.013), with better neonatal outcomes, including lower rates of intrauterine distress (P  0.011), premature birth (P  0.003), and asphyxia (P  0.013). Emotional resilience, coping confidence, and patient satisfaction were significantly higher in the case group (P < 0.05). These findings suggest that psychosomatic medicine may offer a novel approach for managing gestational hypertension through microbiome modulation.  Kulcsszavak: psychosomatic medicine, gestational hypertension, gut microbiome, immune modulation