Abstract / Summary
Physical exercise during pregnancy is associated with important maternal and foetal health benefits. These include reduced risks of gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and excessive gestational weight gain. However, the molecular mechanisms underlying these benefits remain incompletely understood. Exerkines are exercise-responsive signalling molecules released from skeletal muscle and other metabolically active tissues and may contribute to metabolic, vascular, inflammatory, and mitochondrial adaptations. This narrative review critically examines current evidence linking exerkines with maternal exercise and cardiometabolic adaptation during pregnancy, with particular emphasis on GDM, HDP, maternal obesity, placental function, and maternal–placental–foetal communication. Evidence was identified through a comprehensive, iterative search of PubMed/MEDLINE, Scopus, and Web of Science primarily covering literature published between January 2016 and July 2026. Priority was given to human pregnancy studies and clinically relevant outcomes. Pregnancy-specific evidence is currently strongest for irisin, although findings remain heterogeneous. Acute exercise studies also indicate transient changes in circulating fibroblast growth factor 21. Evidence for β-aminoisobutyric acid, apelin, adiponectin, chemerin, and interleukin-6 is more limited and frequently relies on experimental or non-pregnant populations. Overall, current evidence supports exerkines as plausible contributors to the cardiometabolic adaptations associated with maternal exercise, but does not establish them as causal mediators. Their principal value at present lies in providing a biological framework linking established clinical benefits of prenatal exercise with metabolic, vascular, inflammatory, and placental adaptations, while identifying specific pathways that require confirmation in pregnancy-specific longitudinal and intervention studies.