Miriam Stephany Girón Luna fell as she tried to climb the steel mesh barrier near El Paso, Texas on Saturday.
She was taken to hospital where doctors tried to deliver the baby by emergency C-section without success.
Officials say the case indicates a change in how migrants are trying to reach the US amid new restrictions.
President Donald Trump has made the fight against illegal migration to the US a major policy issue and has taken measures to deter entry across the border from Mexico, including plans for a border wall. Large sections of the border near El Paso already have some form of barrier.
Girón Luna was travelling with a 26-year-old man believed to be her partner and the baby's father, and fell more than 6m (19ft), Guatemala's foreign ministry said on Thursday (in Spanish). The man eventually found US border patrol agents, who called for an ambulance to rescue her.
According to the statement, Girón Luna was taken to a hospital in El Paso with a cerebral haemorrhage, liver and kidney lacerations and a pelvis fracture. She underwent multiple surgeries but died from her injuries on Tuesday.
The Guatemalan statement said she was seven months pregnant while US Customs and Border Protection (CBP) said she was eight months.
Gloria Chavez, CBP's El Paso sector chief, blamed the death on "human smugglers" who had "encouraged her and helped her climb" the barrier. "We will engage our law enforcement partners in Mexico to find those responsible for placing these lives in danger," she said in a statement.
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