Exercise and physical activity have been studied and suggested as a way to reduce or minimize the effects of pre-eclampsia. Our aim was to evaluate the association between exercise and/or physical activity and occurrence of pre-eclampsia. We conducted electronic searches without year of publication and language limitations. This was a systematic review designed according to PRISMA. Different databases accessed were as follows: PubMed®; Latin-American and Caribbean Literature in Health Sciences (LILACS); Scientific Electronic Library On-line (SciELO); Physiotherapy Evidence Database (PEDro); and ISI web of KnowledgeSM. The Medical Subject Headings (MeSH) were as follows: ("exercise" OR "motor activity" OR "physical activity") AND ("pre-eclampsia" OR "eclampsia" OR "hypertension, pregnancy-induced"). Inclusion criteria were studies conducted in adults who were engaged in some physical activity. The selection and methodological evaluation were carried out by two independent reviewers. Risk assessment was made by the odds ratio (OR) and incidence of pre-eclampsia in the population who performed physical activity/exercise. A total of 231 articles were found, 214 of which were excluded based on title and full-text, so that 17 remained. Comparison of six case-control studies showed that physical activity had a protective effect on the development of pre-eclampsia [OR 0.77, 95% confidence interval (CI) 0.64-0.91, p < 0.01]. The 10 prospective cohort studies showed no significant difference (OR 0.99, 95% CI 0.93-1.05, p= 0.81). The only randomized clinical trial showed a protective effect on the development of pre-eclampsia in the stretching group (OR 6.34, 95% CI 0.72-55.37, p= 0.09). This systematic review indicates a trend toward a protective effect of physical activity in the prevention of pre-eclampsia. © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.911011471157Arena, B., Maffulli, N., Exercise in pregnancy: How safe is it? 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