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Obstetric pharmacogenomics
1Division of Maternal Fetal Medicine & Clinical Pharmacology, Department of Gynaecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Journal of Basic and Clinical Physiology and Pharmacology
|August 10, 2026
Summary
Pregnancy significantly changes how drugs work due to evolving physiology, making standard pharmacogenomics insufficient. A new framework is proposed for obstetric-pharmacogenomics to personalize drug therapy for pregnant women and their babies.
Area of Science:
- Obstetric pharmacogenomics
- Translational pharmacology
- Precision medicine in pregnancy
Background:
- Physiological changes during pregnancy alter drug disposition (absorption, distribution, metabolism, excretion).
- Current pharmacogenomic models are static and do not account for dynamic gestational changes.
- Limited application of pharmacogenomics in pregnancy hinders precision therapeutics.
Purpose of the Study:
- Propose a conceptual framework for obstetric-pharmacogenomics.
- Integrate maternal, placental, and fetal genomes with the evolving physiologic environment.
- Address the dynamic nature of drug disposition and response during gestation.
Main Methods:
- Mini-review of existing literature and conceptual framework development.
- Discussion of clinical implications across various therapeutic areas.
- Examination of barriers to implementation and future research directions.
Main Results:
- Pregnancy-induced alterations in enzymes (e.g., cytochrome P450), transporters, and placental metabolism modify genetically determined drug responses.
- Static pharmacogenomic classifications are insufficient for pregnant populations.
- Trimester-specific approaches are needed for individualized drug therapy.
Conclusions:
- A dynamic framework for obstetric-pharmacogenomics is essential for personalized drug therapy.
- Integrating pharmacogenomics with physiologically based pharmacokinetic modeling and multi-omics can redefine precision medicine in obstetrics.
- Overcoming research and ethical barriers is crucial for advancing pharmacotherapy in pregnant women and offspring.
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