<p>This review delves into the role of exosomes in immune regulation within the context of preeclampsia (PE), a pregnancy condition marked by high blood pressure and widespread inflammation. PE hampers the invasion of trophoblasts and disrupts placental function, contributing to inflammation and maternal organ dysfunction. Exosomes are small extracellular vesicles that mediate cell-to-cell communication by transferring proteins, lipids, and nucleic acids. This review highlights their role in immune regulation during pregnancy, especially their altered behavior in PE. Normally, exosomes support communication between the mother and fetus, promoting immune tolerance. In PE, however, exosomal activity and content undergo significant changes, potentially intensifying the inflammatory state. Further investigation into the in vivo immune-modulatory actions of exosomes, especially those from preeclamptic placentas, may provide insights into the pathogenesis of PE and uncover novel therapeutic targets for treatment.</p>