Introduction <p>Preconception physical activity may lower the risk of adverse maternal health outcomes. This integrative review examined the relationship between preconception physical activity and maternal health outcomes.</p> Methods <p>Six electronic databases (i.e., Cochrane Library, PubMed, Science Direct, PsycInfo, SAGE Journals, and Sports Discus) were searched for relevant articles. Articles were eligible for inclusion if they were (1) published between January 1, 2016, and January 9, 2025, in an English-language peer-reviewed journal; (2) included a measure of preconception physical activity; and (3) reported maternal health outcomes during or after birth.</p> Results <p>Search procedures retrieved a total of 3608 articles. After a thorough screening process, seven articles met the inclusion criteria of this review. Five articles reported data from prospective cohort studies, and two articles employed cross-sectional designs. Outcomes examined included gestational hypertension (n = 3), gestational diabetes/glucose metabolism (n = 4), preeclampsia (n = 2), infant birth weight (n = 2), pregnancy weight gain (n = 1), duration of pregnancy (n = 1), and mode of delivery (n = 1). Higher preconception physical activity engagement was linked to reduced risks of gestational hypertension (n = 1), gestational diabetes/glucose metabolism (n = 2), preeclampsia (n = 2), low birth weight (n = 1), excessive pregnancy weight gain (n = 1), and post-term delivery (n = 1). Three studies found greater risk reduction with increased moderate-to-vigorous physical activity.</p> Discussion <p>Engaging in regular moderate-to-vigorous physical activity during preconception is associated with a reduced risk of numerous adverse maternal health outcomes.</p>