Abstract: Primary ovarian neuroendocrine tumors Grade 1 (pNET G1) are exceptionally rare during pregnancy, and current literature remains limited regarding their pathological characteristics, diagnostic strategies, and gestational management. Moreover, physiological changes inherent to pregnancy often confound clinical assessment, posing a considerable challenge in balancing maternal-fetal safety with effective tumor control. Herein, we retrospectively analyzed the clinical data, pathological morphology, immunohistochemical profile, and clinical course of a 36-year-old pregnant patient diagnosed with ovarian pNET G1 at Bayannur Hospital. The patient presented with pregnancy-induced hypertension at 39 weeks of gestation and underwent a concurrent cesarean section and ovarian cystectomy. Histopathological examination revealed diffuse immunoreactivity for synaptophysin (Syn), chromogranin A (CgA), and neural cell adhesion molecule (CD56), with a Ki-67 proliferative index of approximately 2%. Integrating these findings with the patient's endocrine symptoms—specifically refractory constipation and labile hypertension—and comprehensive abdominal imaging that excluded distant metastasis, a definitive diagnosis of ovarian pNET G1 was established. No recurrence or metastasis was detected during the 12-month follow-up. This case highlights that pNET G1 within an ovarian teratoma is highly susceptible to being obscured by physiological gestational changes and corpus luteum cysts, leading to frequent missed or delayed diagnoses. Clinicians should maintain a high index of suspicion for hormone-related manifestations such as constipation and hypertension. Establishing an early warning algorithm based on characteristic imaging findings (e. g., mural nodules) and a supportive immunohistochemical panel (Syn, CgA, CD56, and Ki-67) is crucial. Timely surgical intervention under close surveillance is recommended to achieve optimal oncological outcomes while ensuring maternal-fetal safety.