Preeclampsia, which seriously threatens the safety of both mother and infant, is a pregnancy-specific hypertension syndrome. However, there is currently no accurate diagnostic bio-markers available, and its etiology and pathogenesis have not been fully elucidated. Exosomes are extracellular vesicles widely existing in body fluids. They carry a variety of bio-active molecules such as proteins, lipids, and nucleic acids and have many biological functions. The microRNAs (miRNAs) carried by exosomes have the characteristics of specificity, diversity, resistance to degradation, and stable detection. It is found that a variety of differentially expressed miRNAs can be detected in exosomes secreted by placental tissues of patients with preeclampsia, suggesting that they may be involved in the pathogenesis of preeclampsia and become novel potential targets for detection of preeclampsia. This paper reviews the structure and function of exosome-derived miRNAs and their relationship with the pathogenesis of preeclampsia in order to provide new ideas for the pathogenesis, early prediction, diagnosis, and treatment of preeclampsia.