Whether or not vigorous exercise during pregnancy affects birth weight is an important issue because birth weight is the single most important determinant of neonatal mortality. A current meta-analysis of randomised trials of exercise during pregnancy did not find, although also did not exclude, a clinically important effect of exercise on birth weight. Randomised trials may miss the women exercising at the most elite levels during pregnancy. We should remain open-minded on this issue until sufficient evidence is available on which to base recommendations.