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Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 20 December 2025 | Viewed by 608

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Guest Editor
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Division of Fetal Intervention, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA
Interests: maternal–fetal medicine; pregnancy; newborn; obstetrics; high-risk pregnancy; mother-to-child infection; spontaneous abortion; recurrent spontaneous abortion
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Special Issue Information

Dear Colleagues,

It is well known that despite the huge advances in genomics, immunology, ultrasonography, pharmacology, and other fields—they all serve complex pregnancies—the incidence of pathology and the patient care outcomes have continued to be suboptimal. For example, preterm birth is an ongoing challenge for both obstetricians and neonatologists due to limitations in predicting such births. This requires the establishment of a personalized strategy and a clear direction of treatment that takes into account the underlying mechanisms of the condition. Additional complexities include understanding that preterm births can be caused by preterm labor, preterm pre-labor rupture of membranes (PPROM), cervical insufficiency, and iatrogenic preterm delivery due to pregnancy or maternal complications.

As cesarean delivery rates continue to increase worldwide, the morbidity associated with repeat hysterotomies has become a global problem. The placenta accreta spectrum, uterine dehiscence, cesarean scar ectopic pregnancies, and peripartum hysterectomies have also increased in incidence, each with their own morbidity and mortality risks.

As part of the maternal–fetal dyad, infants are also significantly impacted by the intricacies of perinatology. The morbidity and mortality of premature newborns are higher than those of full-term infants.Analysis of this issue has highlighted the importance of the projection of fetal development in utero, continuing with the neonatal period, childhood, and even adulthood. In addition, the advancements in fetal surgery (in utero) interventions have allowed for the earlier treatment of complex fetal conditions.

Future research in the field of maternal–fetal medicine has many complexities to address surrounding the various aspects of care for both the mother and child.

Dr. Jessian Munoz
Guest Editor

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Keywords

  • maternal–fetal medicine
  • preterm delivery
  • preterm birth management
  • newborn
  • obstetrics
  • high-risk pregnancy
  • perinatal outcome
  • placenta accreta, fetal surgery

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Published Papers (1 paper)

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13 pages, 725 KiB  
Systematic Review
Impact of Perioperative Antibiotic Prophylaxis in Caesarean Section on the Maternal Gut Microbiome: A Systematic Review
by Elisabeth AL Feles, Claudio Neidhöfer, Christina Wessels, Rosalie Gruber and Frauke Mattner
J. Clin. Med. 2025, 14(14), 5104; https://doi.org/10.3390/jcm14145104 - 18 Jul 2025
Viewed by 179
Abstract
Background/Objectives: Caesarean section (CS) accounts for over 20% of global births and routinely involves perioperative antibiotic prophylaxis (PAP) to reduce surgical site infections. While the impact of such prophylaxis on neonatal microbiome development is well described, effects on the maternal gut microbiome remain [...] Read more.
Background/Objectives: Caesarean section (CS) accounts for over 20% of global births and routinely involves perioperative antibiotic prophylaxis (PAP) to reduce surgical site infections. While the impact of such prophylaxis on neonatal microbiome development is well described, effects on the maternal gut microbiome remain underexplored. This systematic review synthesizes current evidence on how antibiotic prophylaxis during CS affects maternal gut microbiome composition and diversity—an underrepresented, but clinically relevant aspect of maternal–fetal medicine. Methods: A systematic literature search was conducted in Medline (PubMed), the Cochrane Library, and the WHO International Clinical Trials Registry Platform (ICTRP) through November 2024. Inclusion criteria were defined according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies used molecular techniques to report maternal gut microbiome outcomes (alpha- and beta-diversity). The search concentrated on beta-lactam antibiotics. Reference lists were screened, but no additional grey literature was searched. Synthesis followed the Synthesis Without meta-analysis (SWiM) approach. No review protocol was registered. The review received no external funding. Results: Out of 1011 records, three studies (total 286 mothers) met the inclusion criteria. All reported maternal microbiome outcomes secondarily to infant-focused research. Only one study provided pre- and post-birth stool samples. Applied antibiotic regimens, sequencing methods, and reported microbiome metrics for alpha- and beta-diversity varied considerably, thus limiting comparability of results. Due to high heterogeneity, no formal risk of bias was assessed. While taxonomic diversity changes were inconsistent, significant shifts in functional diversity metrics were observed postpartum. Conclusions: Evidence on maternal microbiome disruption following perioperative antibiotic prophylaxis in CS is methodologically fragmented and limited by small sample sizes and inconsistent antibiotic protocols. Nonetheless, functional diversity appears sensitive to antibiotic exposure. To improve clinical understanding and safety, maternal-focused studies using standardized protocols are urgently needed. The maternal microbiome may play a key role in both recovery and shaping the newborn’s early microbial environment. Full article
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