Objective To explore the latent profile of symptom distress among pregnant women in the third trimester, and to analyze the influencing factors of different latent profiles. Methods From January to June 2024, a convenience sample of 606 pregnant women in the third trimester were surveyed by using a general information questionnaire and the Memorial Symptom Assessment Scale.Latent profile analysis was conducted to analyze the symptom distress of the participants, and logistic regression was used to analyze the influencing factors of each profile. Results The symptom distress among pregnant women in the third trimester were categorized into three profiles: the mild symptom class (42.0%), the moderate symptom class (38.0%), and the severe symptom class (20.0%). Weekly exercise time, pregnancy complications, and conjugal relationship were the influencing factors of profiles of symptom distress (all P<0.05). Conclusion There is heterogeneity of symptom distress among pregnant women in the third trimester, healthcare professionals should identify the characteristics and influencing factors of each category at an early stage and develop targeted clinical symptom management strategies.