Xq28 duplications are a significant cause of X-linked intellectual disability (XLID). While the postnatal features of distal Xq28 duplication syndrome are well characterized, the prenatal phenotypes remain poorly defined due to limited data, posing challenges for genetic counseling. We identified three fetuses carrying 454-558 kb distal Xq28 microduplications through chromosomal microarray analysis (CMA) from 13,084 prenatal cases at our center. The primary indications for diagnosis were abnormal ultrasound findings. Case 1 (male) and case 3 (female) exhibited nasal bone hypoplasia. Case 2 (male) showed increased nuchal translucency (NT) and a persistent right umbilical vein. After genetic counseling, two couples chose to terminate their pregnancies, while one couple continued the pregnancy and delivered a healthy child. Distal Xq28 duplications would present diverse prenatal phenotypes, ranging from normal to abnormal. Skeletal anomalies are the most common prenatal features in symptomatic fetuses with this duplication. Prenatal diagnosis and genetic counseling are essential for providing clinical guidance to the affected families. The correlation between prenatal ultrasound findings and the distal Xq28 duplications requires further investigation in larger cohorts.