Introduction. According to the World Health Organization, the natural and human-transformed natural environment affects the health of urban residents. In modern socio-economic conditions of megapolis there are unfavorable trends of deterioration of health and quality of life indicators of urban population. Pregnancy is a crisis state for both the woman herself and her family as a whole, so it is during this period that a woman needs to ensure a high level of quality of life, which is often not given due attention due to the high rhythm of life in megacities. The course of pregnancy is determined by the development of structural and functional changes in a woman′s body, which in turn affect not only physical well-being, but also mental health, thus changing the level of quality of life of a woman. Along with this physiological changes during pregnancy can serve as a background for the formation of somatic dysfunctions, the clinical manifestations of which are determined by the compensatory capabilities of the body of the pregnant woman. Pregnancy support at the present stage dictates the necessity of timely detection of functional changes and quality of life disorders in order to prevent complications during pregnancy.The aim of the study: to evaluate the osteopathic status and the level of quality of life of pregnant women in megacitiesMaterials and methods. In a cross-sectional cohort study conducted in the period from 03.2018 to 05.2023g on the basis of medical clinics in St. Petersburg (LLC «Institute of Osteopathy Mokhov»), in Moscow (Balashikha Maternity Hospital), in Kazan (City Clinical Hospital № 16) and Medical Clinic «Medexpert» (Kazan) were included 225 somatically healthy pregnant women at different stages of pregnancy, aged 25–45 years. The mean age of the subjects was 34±3,8 years at the time of follow-up. A unified osteopathic examination was performed in all pregnant women with the formation of an osteopathic report and the level of quality of life was assessed according to the criteria of the SF-36 questionnaire.Results. The analysis of the results of the conducted studies demonstrated that as pregnancy progresses, somatic dysfunctions of the pelvic region come to the forefront (p<0,05), and the indicators of the level of both physical and psychological components of the quality of life significantly decrease (p=0,02) with increasing gestational age. At the same time, a significantly lower level of quality of life indicators at baseline and as pregnancy progresses is observed in the residents of Moscow compared to pregnant women living in St. Petersburg and Kazan.Conclusion. Healthy pregnant women are characterized by the presence of somatic dysfunctions of regional and local level, and the frequency of their detection, degree of severity and level of manifestation depends on the term of pregnancy and does not statistically differ in the residents of the cities of St. Petersburg, Moscow and Kazan. As pregnancy progresses, the inhabitants of megacities are characterized by a decrease in both physical and psychological components of quality of life. The fact that we have revealed a statistically significantly lower level of quality of life indicators in women living in Moscow compared to those living in St. Petersburg and Kazan needs further study by specialists.