Drug therapy during pregnancy poses unique challenges, requiring a balance between maternal benefit and fetal safety. Profound physiological changes, including altered plasma volume, protein binding, hepatic metabolism, renal clearance, and placental transfer, transform pregnancy pharmacology into a dynamic process. Classical concepts such as initiation, loading, maintenance, tapering, and therapeutic monitoring remain fundamental but demand gestation-specific adaptations. This overview integrates fundamental pharmacological concepts with clinical practices tailored for pregnancy, such as personalized dosing, therapeutic monitoring, and structured tapering. Recent studies further underscore the role of the maternal gut microbiome in shaping drug metabolism, absorption, and overall exposure. Variations in how individuals respond to medication during pregnancy may stem from microbial enzymes and metabolites that interact with the body's pharmacokinetic processes. By merging microbiome data with physiologically based pharmacokinetic modeling and pharmacometric tools, clinicians can enhance drug disposition forecasts and refine precision dosing strategies in obstetric care.
Ganamurali et al. (Fri,) studied this question.