Maternal exercise during pregnancy is a powerful non-pharmacological intervention to enhance maternal and fetal health. It improves maternal metabolism, cardiovascular function, and neuroendocrine regulation, reducing the risks of conditions like gestational diabetes, obesity, and hypertension. Exercise also enhances placental structure and function, optimizing nutrient transport, angiogenesis, and mitochondrial activity, which support fetal development and reduce risks of growth restriction. For offspring, maternal exercise provides short-term benefits, such as improved birth outcomes, and long-term advantages, including enhanced metabolic, cardiovascular, and cognitive health into adulthood. These effects are mediated by exerkines (e.g., irisin, SOD3, apelin) and epigenetic modifications. Despite these promising findings, further research is needed to standardize exercise protocols and fully understand the molecular mechanisms involved.