{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:04:34Z","timestamp":1792681474210,"version":"4.5.0"},"reference-count":19,"publisher":"Walter de Gruyter GmbH","issue":"5","funder":[{"DOI":"10.13039\/100000071","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["DP1HD115433"],"award-info":[{"award-number":["DP1HD115433"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Pregnancy profoundly alters drug disposition through dynamic physiologic adaptations affecting absorption, distribution, metabolism, and excretion. Although pharmacogenomics has transformed precision therapeutics across multiple medical specialties, its application during pregnancy remains limited because conventional pharmacogenomic models assume stable genotype-phenotype relationships that do not account for the temporal biologic changes of gestation. This mini-review proposes a conceptual framework for obstetric-pharmacogenomics in which maternal, placental, and fetal-genomes interact within a continuously evolving physiologic environment to shape drug exposure, therapeutic efficacy, and toxicity. Pregnancy-induced alterations in cytochrome P450 enzyme activity, drug transporters, placental metabolism, and immune regulation may amplify, attenuate, or fundamentally modify genetically determined drug responses, rendering static pharmacogenomic classifications insufficient. We discuss the clinical implications of this dynamic paradigm across several therapeutic areas, including antiretroviral therapy, maternal mental health, hypertensive disorders of pregnancy, and analgesia, and highlight the need for trimester-specific approaches to individualized drug therapy. We further examine current barriers to implementation, including the exclusion of pregnant women from pharmacogenomic research, limited longitudinal data, and ethical considerations surrounding fetal genetics. Integrating pharmacogenomics with physiologically based pharmacokinetic modeling and multi-omics technologies offers an opportunity to redefine precision-medicine in obstetrics and advance safer, more effective, and individualized pharmacotherapy for pregnant-women and their offspring.<\/jats:p>","DOI":"10.1515\/jbcpp-2026-0183","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:55:26Z","timestamp":1786355726000},"page":"355-360","source":"Crossref","is-referenced-by-count":1,"title":["Obstetric pharmacogenomics"],"prefix":"10.1515","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0070-9840","authenticated-orcid":false,"given":"Ahizechukwu Chigoziem","family":"Eke","sequence":"first","affiliation":[{"name":"Division of Maternal Fetal Medicine & Clinical Pharmacology, Department of Gynaecology and Obstetrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_001","doi-asserted-by":"crossref","unstructured":"Lauschke, VM, Ingelman-Sundberg, M. The evolving landscape of pharmacogenomics: current achievements and future directions. Pharmacol Rev 2026;78:100122. https:\/\/doi.org\/10.1016\/j.pharmr.2026.100122.","DOI":"10.1016\/j.pharmr.2026.100122"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_002","doi-asserted-by":"crossref","unstructured":"Eke, AC. An update on the physiologic changes during pregnancy and their impact on drug pharmacokinetics and pharmacogenomics. J\u00a0Basic Clin Physiol Pharmacol 2022;33:581\u201398. https:\/\/doi.org\/10.1515\/jbcpp-2021-0312.","DOI":"10.1515\/jbcpp-2021-0312"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_003","doi-asserted-by":"crossref","unstructured":"Mao, Q, Chen, X. An update on placental drug transport and its relevance to fetal drug exposure. Mediev Rev 2022;2:501\u201311. https:\/\/doi.org\/10.1515\/mr-2022-0025.","DOI":"10.1515\/mr-2022-0025"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_004","doi-asserted-by":"crossref","unstructured":"Taylor, C, Crosby, I, Yip, V, Maguire, P, Pirmohamed, M, Turner, RM. A review of the important role of CYP2D6 in pharmacogenomics. Genes 2020;11. https:\/\/doi.org\/10.3390\/genes11111295.","DOI":"10.3390\/genes11111295"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_005","doi-asserted-by":"crossref","unstructured":"Brice\u00f1o-Pati\u00f1o, N, Prieto, MC, Manrique, P, Calderon-Ospina, CA, G\u00f3mez, L. Pharmacokinetic adaptations in pregnancy: implications for optimizing antiretroviral therapy in HIV-positive women. Pharmaceutics 2025;17. https:\/\/doi.org\/10.3390\/pharmaceutics17070913.","DOI":"10.3390\/pharmaceutics17070913"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_006","doi-asserted-by":"crossref","unstructured":"Li, D, Pain, O, Fabbri, C, Wong, WLE, Lo, CWH, Ripke, S, et al.. Metabolic activity of CYP2C19 and CYP2D6 on antidepressant response from 13 clinical studies using genotype imputation: a meta-analysis. Transl Psychiatry 2024;14:296. https:\/\/doi.org\/10.1038\/s41398-024-02981-1.","DOI":"10.1038\/s41398-024-03064-x"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_007","doi-asserted-by":"crossref","unstructured":"Pennell, PB, Peng, L, Newport, DJ, Ritchie, JC, Koganti, A, Holley, DK, et al.. Lamotrigine in pregnancy: clearance, therapeutic drug monitoring, and seizure frequency. Neurology 2008;70:2130\u20136. https:\/\/doi.org\/10.1212\/01.wnl.0000289511.20864.2a.","DOI":"10.1212\/01.wnl.0000289511.20864.2a"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_008","doi-asserted-by":"crossref","unstructured":"Luizon, MR, Pereira, DA, Sandrim, VC. Pharmacogenomics of hypertension and preeclampsia: focus on gene\u2013gene interactions. Front Pharmacol 2018;9:168. https:\/\/doi.org\/10.3389\/fphar.2018.00168.","DOI":"10.3389\/fphar.2018.00168"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_009","doi-asserted-by":"crossref","unstructured":"Nahid, NA, Johnson, JA. CYP2D6 pharmacogenetics and phenoconversion in personalized medicine. Expert Opin Drug Metabol Toxicol 2022;18:769\u201385. https:\/\/doi.org\/10.1080\/17425255.2022.2160317.","DOI":"10.1080\/17425255.2022.2160317"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_010","doi-asserted-by":"crossref","unstructured":"Eke, AC, Olagunju, A, Best, BM, Mirochnick, M, Momper, JD, Abrams, E, et al.. Innovative approaches for pharmacology studies in pregnant and lactating women: a viewpoint and lessons from HIV. Clin Pharmacokinet 2020;59:1185\u201394.","DOI":"10.1007\/s40262-020-00915-w"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_011","doi-asserted-by":"crossref","unstructured":"Eke, AC, Olagunju, A, Momper, J, Penazzato, M, Abrams, EJ, Best, BM, et al.. Optimizing pharmacology studies in pregnant and lactating women using lessons from HIV: a consensus statement. Clin Pharmacol Therapeut 2021;110:36\u201348. https:\/\/doi.org\/10.1002\/cpt.2048.","DOI":"10.1002\/cpt.2048"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_012","doi-asserted-by":"crossref","unstructured":"Caudle, KE, Whirl-Carrillo, M, Relling, MV, Hoffman, JM, Donnelly, RS, Haidar, CE, et al.. Advancing clinical pharmacogenomics worldwide through the clinical pharmacogenetics implementation consortium (CPIC). Clin Pharmacol Therapeut 2025;118:1512\u201322. https:\/\/doi.org\/10.1002\/cpt.70005.","DOI":"10.1002\/cpt.70005"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_013","doi-asserted-by":"crossref","unstructured":"Abdullah-Koolmees, H, van Keulen, AM, Nijenhuis, M, Deneer, VHM. Pharmacogenetics guidelines: overview and comparison of the DPWG, CPIC, CPNDS, and RNPGx guidelines. Front Pharmacol 2020;11:595219. https:\/\/doi.org\/10.3389\/fphar.2020.595219.","DOI":"10.3389\/fphar.2020.595219"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_014","doi-asserted-by":"crossref","unstructured":"Brouwer, J, Nijenhuis, M, Soree, B, Guchelaar, HJ, Swen, JJ, van Schaik, RHN, et al.. Dutch pharmacogenetics working group (DPWG) guideline for the gene-drug interaction between CYP2C19 and CYP2D6 and SSRIs. Eur J Hum Genet: EJHG 2022;30:1114\u201320. https:\/\/doi.org\/10.1038\/s41431-021-01004-7.","DOI":"10.1038\/s41431-021-01004-7"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_015","doi-asserted-by":"crossref","unstructured":"Gong, L, Whirl-Carrillo, M, Klein, TE. PharmGKB, an integrated resource of pharmacogenomic knowledge. Curr Protoc 2021;1:e226. https:\/\/doi.org\/10.1002\/cpz1.226.","DOI":"10.1002\/cpz1.226"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_016","doi-asserted-by":"crossref","unstructured":"Betcher, HK, George, ALJr. Pharmacogenomics in pregnancy. Semin Perinatol 2020;44:151222. https:\/\/doi.org\/10.1016\/j.semperi.2020.151222.","DOI":"10.1016\/j.semperi.2020.151222"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_017","doi-asserted-by":"crossref","unstructured":"Eke, AC, Gebreyohannes, RD. Physiologically based pharmacokinetic modeling (PBPK\u2019s) prediction potential in clinical pharmacology decision making during pregnancy. Int J Gynaecol Obstet: Off Organ Int Federat Gynaecol Obstet 2020;150:414\u20136. https:\/\/doi.org\/10.1002\/ijgo.13150.","DOI":"10.1002\/ijgo.13150"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_018","doi-asserted-by":"crossref","unstructured":"Ozen, M, Aghaeepour, N, Mari\u0107, I, Wong, RJ, Stevenson, DK, Jantzie, LL. Omics approaches: interactions at the maternal-fetal interface and origins of child health and disease. Pediatr Res 2023;93:366\u201375. https:\/\/doi.org\/10.1038\/s41390-022-02335-x.","DOI":"10.1038\/s41390-022-02335-x"},{"key":"2026092511254138564_j_jbcpp-2026-0183_ref_019","doi-asserted-by":"crossref","unstructured":"Babu, M, Lautman, Z, Lin, X, Sobota, MHB, Snyder, MP. Wearable devices: implications for precision medicine and the future of health care. Annu Rev Med 2024;75:401\u201315. https:\/\/doi.org\/10.1146\/annurev-med-052422-020437.","DOI":"10.1146\/annurev-med-052422-020437"}],"container-title":["Journal of Basic and Clinical Physiology and Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jbcpp-2026-0183\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jbcpp-2026-0183\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:25:53Z","timestamp":1790335553000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jbcpp-2026-0183\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,8,11]]},"published-print":{"date-parts":[[2026,9,25]]}},"alternative-id":["10.1515\/jbcpp-2026-0183"],"URL":"https:\/\/doi.org\/10.1515\/jbcpp-2026-0183","relation":{},"ISSN":["0792-6855","2191-0286"],"issn-type":[{"value":"0792-6855","type":"print"},{"value":"2191-0286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]}}}