During pregnancy, uterine circulation undergoes profound structural and functional adaptations to accommodate the dramatically increased metabolic demands of the growing fetus. Oxidative stress (OS) and inflammation have emerged as central regulators both physiologically, to drive vascular remodeling and angiogenesis, and pathologically, when dysregulated, to promote endothelial dysfunction, maladaptive extracellular matrix (ECM) remodeling, and heightened arterial stiffness. This review synthesizes insights into the molecular sources of reactive oxygen species (ROS) in the uterine vasculature, endothelial and immune-mediated inflammatory pathways, the bidirectional crosstalk between OS and inflammation, and their combined impact on vascular stiffness. We further discuss clinical implications for conditions such as preeclampsia and intrauterine growth restriction (IUGR), highlight circulating and imaging biomarkers of redox–inflammatory imbalance, and evaluate antioxidant and anti-inflammatory therapeutic strategies. Finally, we identify critical knowledge gaps and propose future research directions aimed at translating mechanistic understanding into personalized maternal–fetal care. For this narrative review, we searched the PubMed and Web of Science databases to identify all human and animal studies investigating OS and inflammation on uterine vasculature remodeling during pregnancy.
Maurizio Mandalà (Tue,) studied this question.