ABSTRACT: Background: Body image in pregnancy has been linked to maternal and neonatal health. This study examined the relationship between prepregnancy body weight and body image change in primigravid women. Methods: Through a self-administered, free-response questionnaire, 76 primigravidas of at least 30 weeks' gestation described their feelings about current appearance and body shape and compared these to prepregnancy feelings. Respondents also completed the Body Shape Questionnaire to measure current concern with body shape. Results: Women who were overweight before pregnancy were more likely to have had a positive change in body image when they were ut more than 30 weeks' gestation. Women who were normal weight before pregnancy were more likely to have had a negative change. Despite overweight women's positive changes, their body shape concerns were more negative than those of normal weight women. Conclusions: Our study highlights the relationship between social values, prepregnancy body weight, and body image change during pregnancy. Some women may benefit from discussing their experiences in a patient-centered context.