Harnessing exosome-based drug delivery for the management of pregnancy-related disorders: a new frontier in obstetric therapeutics

Obstetric complications, such as preeclampsia, preterm birth, and foetal growth restriction significantly impact maternal and neonatal health globally, contributing substantially to maternal and perinatal morbidity and mortality. These conditions often result in long-term health sequelae for affected offspring, including neurodevelopmental disorders, metabolic syndrome, and cardiovascular diseases. Despite advances in prenatal diagnostics and neonatal care, therapeutic options remain limited due to challenges imposed by the placental barrier, such as poor drug permeability, low bioavailability, and safety concerns. Exosomes, naturally occurring extracellular vesicles, offer promising solutions as targeted drug delivery systems due to their excellent biocompatibility, low immunogenicity, and ability to cross biological barriers. Specifically, exosomes are gaining recognition for their roles in maternal-foetal communication and immunological regulation, presenting potential both as biomarkers and therapeutic carriers in obstetric care. This review synthesises current knowledge of exosome properties, their physiological and pathological roles in pregnancy, and explores their potential as innovative therapeutic delivery platforms. Additionally, the review addresses existing challenges in exosome technology, including production scalability, standardisation, and safety, and outlines critical directions for future research and clinical translation.