Extracellular vesicles (EVs) are small membrane-bound particles that facilitate communication between cells. They do this by carrying cargo such as proteins, microRNAs, and other signaling molecules between cells. EVs come in a variety of sizes, the smallest of which are called exosomes. Many essential physiological functions are mediated by EVs, including pregnancy. The umbilical cord, placenta, amniotic fluid, and amniotic membranes can all release exosomes. Exosomes play roles in egg implantation, embryo formation, and fetal-maternal communication and can even influence both male and female fertility. Angiogenesis — or the formation of new blood vessels — during pregnancy is also largely regulated by exosomes. The contents of exosomes influence pregnancy-related disorders including gestational diabetes mellitus, preterm birth, and fetal growth restriction. While more research into the function of exosomes in pregnancy is needed, their key roles in normal and complex pregnancies make exosomes promising potential therapeutic targets and diagnostic markers.