Pregnancy is a complex physiological process. In recent years, it has been discovered that exosomes play a crucial regulatory role in both physiological and pathological pregnancies by facilitating communication between the mother and fetus. Exosomes regulate various biological functions, such as embryo implantation, angiogenesis, endothelial cell migration, and resistance to viral infections. Additionally, they mediate maternal-fetal immune tolerance by modulating immune cells such as natural killer (NK) cells, T cells, and monocytes. Furthermore, exosomes are involved in the regulation of multiple pregnancy complications, including preeclampsia, gestational diabetes mellitus, preterm delivery, and fetal growth restriction.This article elaborates on the regulatory role of exosomes in physiological and pathological pregnancies,offering valuable insights for the future diagnosis and treatment of these pregnancy complications.