<p>Pregnant people carrying fetuses with congenital anomalies are at increased risk for depressive symptoms. However, the nature of these symptoms is not well-understood. The present study identified profiles of prenatal depressive symptomatology and examined demographic and clinical predictors of profile membership. Pregnant persons (<i>N</i> = 6657) with a confirmed structural fetal anomaly diagnosis at a maternal–fetal care center completed psychosocial measures. K-means clustering analyses identified profiles. ANOVA and chi-square analyses evaluated predictors. Four profiles emerged: Minimal Depressive Type (<i>n</i> = 2259, 33.93%), Emotionally Dysregulated Type (<i>n</i> = 1909, 28.68%), Anxious and Somatic Type (<i>n</i> = 1789, 26.87%), and High Depressive Type (<i>n</i> = 700, 10.52%); indicating a higher likelihood of somatic, anxious, and emotion dysregulation symptoms rather than feelings of guilt/shame and loss of self. Racial identity, number of live births, antidepressant use, relationship with father of baby, and insurance status were associated with profile membership. Findings contribute to the understanding of perinatal depression among those with fetal anomalies, and highlight the need to further examine the clinical utility of depression profiles and responsiveness to psychosocial intervention.</p>