During pregnancy, women are vulnerable to mood and anxiety disorders due to the significant physical and emotional changes that occur during this period. For some women, pregnancy can also present as a period of immense body dissatisfaction due to the substantial changes in body shape and size. Objectives This study examined the mediating role of Fat Talk (i.e., engaging in disparaging comments about one's body shape and size with others) in the relationship between (a) body dissatisfaction and distress in pregnant women (i.e., pregnancy-related anxiety, depression and eating disorder symptomatology), and (b) sociocultural pressure to meet the thin ideal and distress. Method A nonclinical sample of 408 pregnant women (Mage = 28.24 years, S Dage = 5.04, range 18–44 years) completed measures of body dissatisfaction, sociocultural pressure, pregnancy-related anxiety, depression and eating disorder symptomatology. Findings Analyses confirmed the partial mediating role of Fat Talk between body dissatisfaction and all three measures of distress, when examined individually. Fat Talk also mediated the relationship between sociocultural pressure (i.e., peers/family and media) and the three measures of distress. Age also partially mediated the relationship between body dissatisfaction and a composite measure of pregnancy distress. Conclusions The results suggest that women face sociocultural pressures for thinness and body dissatisfaction even when pregnant, and that engaging in Fat Talk contribute to greater levels of pregnancy-related anxiety, depression and eating disorder symptomatology. The role of Fat Talk in regard to pregnancy distress may be more pertinent to younger women.