Obstetric pharmacotranscriptomics

Pregnancy produces gestational-age and tissue-specific transcriptional remodeling in maternal blood, placenta, decidua, fetal membranes, and fetal compartments that can modify pathways governing drug disposition and response. Obstetric pharmacotranscriptomics seeks to relate these dynamic expression states to medication exposure, target engagement, efficacy, and toxicity.

This narrative review defines obstetric pharmacotranscriptomics, distinguishes pregnancy- and disease-associated expression from medication-induced transcriptional effects, and evaluates current evidence from maternal blood, cell-free RNA, placenta, and pregnancy-relevant experimental models. PubMed/MEDLINE and Google Scholar were searched from database inception through 15 September 2026, using combinations of pregnancy, placenta, transcriptomics, RNA sequencing, pharmacotranscriptomics, drug response, medication exposure, pharmacokinetics, pharmacodynamics, cytochrome P450, UDP-glucuronosyltransferase (uridine 5'-diphospho-glucuronosyltransferase), ATP-binding cassettes, solute carrier transporters, and specific obstetric medications. Priority was given to human pregnancy studies, longitudinal designs, direct drug-perturbation experiments, and mechanistically informative preclinical studies.

Pregnancy transcriptomics is substantially more mature than pregnancy pharmacotranscriptomics. The strongest path forward is to embed longitudinal transcriptomic sampling within pharmacokinetic and therapeutic studies so that gestational biology, drug exposure, target engagement, efficacy, and toxicity can be distinguished. Clinically useful signatures will require independent validation, tissue and cell-type specificity, demonstrated incremental value over standard clinical predictors, and conversion to reproducible targeted assays.