Immunology of pregnancy and sepsis: shared and specific pathways guiding future precision care.

Abstract

Maternal sepsis remains a leading cause of preventable death globally, yet its underlying biology within the context of pregnancy is poorly understood. This review examines the extent to which pregnancy and sepsis share physiological, immunological, and regulatory pathways. We propose a unifying model for maternal sepsis that integrates immune, transcriptomic, epigenetic, and metabolic frameworks to advance a precision medicine approach, restoring immune equilibrium, controlling pathological inflammation while preserving pregnancy-specific adaptations. We address key knowledge gaps in current precision maternal care in sepsis and discuss the potential and limitations of emerging approaches supporting individualised risk assessment, trimester-specific immune monitoring, and targeted recovery interventions. Pregnancy itself serves as a model for natural immunological equilibrium, where tolerance and defence are finely balanced, offering broader insights for sepsis management beyond obstetrics. Translating these insights into equitable, pregnancy-compatible therapeutic strategies is an exciting opportunity to reduce the global burden of maternal sepsis and improve outcome.