Background: Pregnancy is one of the most anticipated moments in women's lives. However, biological and physiological changes cause a lot of discomfort. Pilates exercise one of the fastest-growing modalities of exercise relief and welfare to these women. Aim of the study: Evaluate the effectiveness of Pilates exercise program during pregnancy on maternal outcomes in maternal and child health care centers at Assiut City. Setting: The study was carried out in two maternal and child health care centers which selected randomly namely El-waledia and Gharb Elbald health care centers. Methods: A Quasi experimental research design (pre and posttest) and Purposeful sample were utilized in this study; A total of 53 pregnant women. Tools of the study: Interviewing questionnaire; it included three tools: Tool I: divided into three parts: personal data, medical and obstetrical history, current pregnancy and labour data. Tool II: Visual Analogue scale to assess back and leg pain. Tool III: Revised Urinary Incontinence Scale. Results: 50.9% of studied sample aged ≥30 years old, 73.6%, and 45.1% of them were multigravida and primipara respectively. 69.8% didn't practice exercise and the mean ±SD of gestational weeks was (27.23 ± 2.18).There was statistically significant relation between leg pain, urinary incontinence before and after exercise (P value=0.000) among studied sample. Conclusion: The Pilates exercise program had significant effect on improving maternal outcomes. Recommendations: Health care providers should encourage pregnant women to engage in physical activity including Pilate's exercise which have been shown more benefits for most women.