Obstetric pharmacoeconomics

INTRODUCTION: Pharmacoeconomic principles are increasingly shaping modern obstetric pharmacology as maternal therapeutics become more complex, costly, and precision-driven. Rising rates of hypertensive disorders of pregnancy, gestational diabetes, obesity, maternal cardiovascular disease, and medically complicated pregnancies have intensified the need for cost-effective therapeutic strategies that optimize maternal and neonatal outcomes while minimizing unnecessary healthcare expenditure. AREAS COVERED: This review examines contemporary pharmacoeconomic concepts in obstetric pharmacology, including cost-effectiveness analysis, quality-adjusted life years, implementation science, and value-based maternal therapeutics. Major domains reviewed include antihypertensive therapy, aspirin prophylaxis, diabetes pharmacotherapy, antiretroviral therapy in pregnancy, anticoagulation, perinatal mental health, lactation, fetal therapeutics, pharmacogenomics, precision dosing, digital health integration, and emerging artificial intelligence applications in maternal fetal medicine. The review further explores linked maternal-child outcome modeling, implementation-sensitive economic evaluation, and the growing role of pharmacometrics and biomarker-guided therapeutics in precision pregnancy care. The review also proposes a life-course framework linking pregnancy therapeutics to inter-generational health, implementation outcomes, and sustainable maternal healthcare systems globally. EXPERT OPINION: Obstetric pharmacology is entering a precision-medicine era in which therapeutic value will increasingly depend on individualized biologic profiling, implementation feasibility, and long-term maternal-child outcomes rather than short-term efficacy alone. Future pharmacoeconomic frameworks must move beyond traditional cost analyses toward integrated models incorporating precision therapeutics, biomarker-guided treatment strategies, real-world effectiveness, and lifespan maternal cardiovascular risk reduction.