Purpose: The purpose of this study was to investigate the effects of Pilates exercise on the back pain index, pelvic tilt angle, and physical fitness of pregnant women with low back pain. Methods: All study participants, all of whom had pregnancy-induced back pain, were randomly assigned to either a Pilates exercise group (PG, n = 8) or control group (CG, n = 7). The PG performed a Pilates exercise for 50 minutes three times a week for eight weeks. The back pain scale and pelvic tilt angle were measured using a visual analogue scale and angulometer, respectively. Cardiopulmonary endurance, flexibility, and grip strength were measured to examine the physical fitness. The variables were analyzed using two-way repeated-measures ANOVA with the Holm-Sidak post hoc procedure. Results: Back pain in the PG significantly decreased from 4.69 ± 1.28 to 1.06 ± 0.94, whereas the CG showed significantly increased back pain from 2.63 ± 2.20 to 4.71 ± 2.56. The left pelvic angle in the PG showed a significant decrease from 13.94 ± 3.70° to 12.29 ± 2.95°, while the CG showed a non-significant difference from 13.07 ± 4.42° to 17.37 ± 3.13°. The right pelvic angle in the PG showed a significant decrease from 13.50 ± 4.47° to 10.34 ± 3.66°, while a non-significant difference in the CG from 44 ± 4.98° to 15.30 ± 3.61° was found. These results showed that the regular participation in Pilates exercise was effective in reducing the pelvic tilt angle. In terms of physical fitness, the PG showed a significant increase in cardiopulmonary endurance, flexibility, and grip strength. However, the CG showed any significance increase in those variables. Conclusion: Eight weeks of Pilates exercise was associated with a decrease in lower back pain, a maintained or reduced pelvic tilt angle, and increased cardiopulmonary endurance, grip strength, and flexibility in pregnant woman with lumbar pain.