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Life sciences · Review
Future Science Oa · November 6, 2026
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INTRODUCTION: Pregnancy-related physiologic and metabolic changes influence drug exposure and response. Yet therapeutic decisions often lack individualized biologic guidance. Obstetric pharmacometabolomics uses endogenous metabolic signatures to investigate and potentially predict and monitor drug response in pregnancy. AREAS COVERED: PubMed/MEDLINE and Google Scholar were searched from inception through October 12, 2026, using terms related to metabolomics, pharmacometabolomics, medication exposure, treatment response, maternal-placental-fetal metabolism, pharmacokinetics, pharmacodynamics, and obstetric medications. Human pregnancy studies, longitudinal investigations, drug-perturbation experiments, and mechanistic preclinical studies were prioritized. This review examines pregnancy-specific metabolic adaptations, analytical approaches, and potential applications involving aspirin, antihypertensives, antidiabetic therapies, antiretrovirals, antimicrobials, corticosteroids, and psychiatric medications. It also considers pharmacometabolic approaches to preeclampsia, gestational diabetes mellitus, preterm birth, fetal growth disorders, obesity, and HIV-associated pregnancy. EXPERT OPINION: Obstetric pharmacometabolomics offers a promising framework for individualized therapeutics, but clinical implementation requires longitudinal studies, standardized biospecimen collection, rigorous exposure assessment, validated biomarkers, and diverse populations. Integration with pharmacogenomics, pharmacomicrobiomics, pharmacoproteomics, and model-informed drug development can improve therapeutic precision, provided that clinical utility is demonstrated.