Effects of physical activity on platelet activation and hemostasis during pregnancy - are placento-exerkines the hidden drivers?

Pregnancy is characterized by a physiological shift toward a prothrombotic state, which is not only preventing postpartum hemorrhage but also contributing to the pathogenesis of placental disorders such as preeclampsia and fetal growth restriction. Platelets, central regulators of hemostasis and vascular remodeling, play a critical role in placental development and function. Emerging evidence suggests that maternal physical activity (PA) can beneficially modulate platelet activation, reduce hypercoagulability, and improve vascular health, yet its specific impact on placental hemostasis remains underexplored. Although PA is increasingly recognized as a powerful nonpharmacological strategy in prenatal care, many women do not meet the recommended criteria during pregnancy. This review explores current knowledge on PA during pregnancy, emphasizing its effects on platelet behavior and downstream consequences for placental integrity. We discuss how regular and moderate-intensity exercise may lead to the release of signal molecules (eg, exerkines), which may alter platelet reactivity and secretion profiles, potentially influencing trophoblast function and uteroplacental blood flow. We also examine the implications of PA in pregnancy pathologies such as gestational diabetes mellitus and preeclampsia, where exaggerated platelet activation and endothelial dysfunction contribute to poor outcomes. Finally, we highlight the clinical relevance of these findings, advocating for the incorporation of personalized, safe PA recommendations into prenatal care. By linking maternal exercise with hemostatic balance and placental health, this review supports a growing paradigm shift toward preventive, lifestyle-based strategies in obstetric care.