Objective To examine the latent profiles of body image in pregnant women and the relationship with fear of childbirth, so as to provide a reference for improving body image and reducing fear of childbirth.Methods From January to August 2024, 503 pregnant women from the obstetrics outpatient department of a tertiary hospital were selected using convenience sampling method.Then they were investigated by using a general information questionnaire, the Body Understanding Measure for Pregnancy Scale, the Body Appreciation Scale, the Functionality Appreciation Scale, the Childbirth Attitudes Questionnaire, the Body Acceptance by Others Scale-2, the Generalized Anxiety Scale-2, and the Patient Health Questionnaire-2.Latent profile analysis,univariate analysis and multivariate analysis were used to analyze data.Results There were three latent profiles of body image in pregnant women:low positive-high negative body image (14.1%), moderate positive-high negative body image (28.2%) and high functional appreciation-low negative body image (57.7%).Age and body acceptance by others were significant influencing factors of the latent profiles of body image during pregnancy (all P＜0.05).Body appreciation and functional appreciation were negatively correlated with fear of childbirth, while negative body image was positively correlated with fear of childbirth.Pregnant women in the high functional appreciation-low negative body image group had the lowest total score and subscale scores in fear of childbirth when compared with other groups (all P＜0.05).Conclusion There is heterogeneity in body image among pregnant women, and it is influenced by various factors.Body image is significantly associated with fear of childbirth.Women′s body image during pregnancy should be comprehensively evaluated, and targeted monitoring and nursing interventions should be carried out to reduce fear of childbirth.