Introduction and Hypothesis <p>This study examined the association between clinical Pilates participation during pregnancy and postpartum biopsychosocial health, focusing on pelvic floor symptoms, body awareness, depressive symptoms, low back pain, and postpartum quality of life.</p> Methods <p>In this cross-sectional study, 69 women were assessed at 6 weeks postpartum (clinical Pilates group, <i>n</i> = 34; control group, <i>n</i> = 35). Assessments included the Body Awareness Questionnaire (BAQ), Pelvic Floor Distress Inventory-20 (PFDI-20), Maternal&#xa0;Postpartum Quality of Life Questionnaire (MAPP-QOL), Edinburgh Postnatal Depression Scale (EPDS), Postpartum Functional Status Inventory (PFSI), Multidimensional Assessment of Fatigue (MAF), and the Visual Analog Scale (VAS) for low back pain.</p> Results <p>Women in the clinical Pilates group had significantly higher BAQ and MAPP-QOL scores and significantly lower EPDS and VAS scores compared with the control group (all <i>p</i> &lt; 0.001). Control participants had higher scores on the colorectal–anal distress subscale of the PFDI-20 (<i>p</i> = 0.029), whereas no significant differences were observed in the total PFDI-20 score, PFSI, or MAF (all <i>p</i> &gt; 0.05). After adjustment for relevant demographic and obstetric confounders, these associations remained significant.</p> Conclusions <p>Participation in clinical Pilates during pregnancy was associated with improved body awareness and postpartum quality of life, and with fewer depressive symptoms and low back pain. These findings suggest that clinical Pilates might be a valuable component of prenatal exercise counseling to promote maternal well-being.</p>