Women’s appearances are often judged by stringent, societal expectations, notably that of the thin-ideal. Pregnancy presents a definitive, yet naturally-occurring deviation from this norm. Research findings on how pregnant women cope with bodily changes however, are equivocal. Some feel protected from appearance-related concerns, whilst others experience increased body dissatisfaction. The aim of the present research was to build a composite understanding of factors that have an influence on body image attitudes and coping strategies in nulliparous women. Underpinned by a new realist and pragmatic approach, the research comprised of qualitative and quantitative components. The first aim was to explore messages about the pregnant body, and the role of exercise in UK magazines and online news sites. A qualitative, thematic examination of articles revealed a stark “invisibility” of the pregnant body in fashion magazines and a disparity in exercise messages and bodily portrayals among news and magazine publications. Overwhelmingly, beauty equated with the thin-ideal, not the pregnant body in news sites and fashion magazines. Study 1’s findings and existing pregnancy research guided Study 2; an exploration of women’s thoughts about their pregnant bodies, the role of exercise, and media-related, bodily descriptions. Semi-structured interviews were conducted with nine pregnant women. Thematic analysis revealed that although women accepted their pregnant bodies, they experienced unwelcomed appearance-related comments, comparisons, and physical contact by others. Their pregnant bodies were perceived as being persistently scrutinised. Finally, a quantitative exploration of appearance-related experiences was conducted, using an online questionnaire administered to 181 pregnant women. Guided by Cash’s (2011a) theoretical model, a multitude of complex factors were examined using path analysis. The model revealed that body appreciation / acceptance, body shame and surveillance, fitness / health attitudes, and appearance evaluation / investment were influenced by historical (e.g., self-esteem, public self-consciousness) and proximal factors (e.g., social comparison). Exercise participation, clothing for concealment, and avoidance / fixing behaviours were associated with shame and surveillance, appearance comparisons, and physical discomforts in pregnancy. The present research indicates that women experience complex appearance- and fitness-related issues in pregnancy. The research concludes by highlighting the importance of nurturing self-esteem in pregnancy to increase body confidence and protect against negative coping strategies through the transition towards motherhood.