Pregnancy is a unique physiologic state that is associated with profound alterations in maternal metabolic, endocrine, and vascular function, designed to ensure the delivery of appropriate energy and nutrition to the developing fetus. In this context, the role of the fat-derived hormone adiponectin is of interest, particularly in light of emerging recognition of the broad array of physiologic processes upon which this adipokine impacts. Indeed, adiponectin has pleiotropic effects on the regulation of energy homeostasis, systemic inflammation, vascular function, cell growth, and even bone metabolism. Thus, in this review, we consider existing evidence for the physiologic role of adiponectin in human gestation and how this protein may be relevant to two major medical disorders of pregnancy: gestational diabetes mellitus and preeclampsia. While studies to date have yielded many conflicting findings pertaining to adiponectin in pregnancy, further investigation in this area is essential. Ultimately, elucidation of adiponectin physiology in the setting of both normal pregnancy and its pathologic conditions may provide unique insight into fundamental processes that are relevant to health and disease in mother and child.