Background: Water exercise is a form of physical exercise which is considered ideal for many people including the elderly, obese patients, and patients with arthritis. Recently, several studies have discussed water exercise and its role for pregnant women as it has shown promising effects om maternal and neonatal outcomes Methods: We followed the standard methods of Cochrane Handbook of Systematic Reviews for interventions and the PRISMA statement guidelines 2020 when conducting and reporting this study. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until December 2021. We selected randomized controlled trials (RCTs) assessing the efficacy of water-based exercise on pregnant women, and all relevant outcomes were pooled in the meta-analysis using Review Manager Software Results: Six RCTs were included in our study with only four RCTs included in the meta-analysis. For maternal outcomes, there was no significant difference between the two groups in terms of “days of gestation” [MD=-0.22 CI 95% (-1.80, 1.36), p=0.78], “vaginal delivery” [RR=0.97 CI 95% (0.90, 1.03), p=0.03), “cesarean delivery” [RR=1.36, CI 95% (0.96, 1.92)], “induced labor” [RR=0.78 CI 95% (0.58, 1.05)], “vaginal tear” [RR=0.95 CI 95% (0.77, 1.16)], and “episiotomy” [RR=0.88 CI 95% (0.66, 1.18)]. For neonatal outcomes, there was no significant difference in term of “neonatal weight” [MD-0.02 CI 95% (0.09, 0.05), p=0.61].