Specialized pro-resolving mediators: key regulators in placental function and pregnancy complications.

Specialized pro-resolving mediators (SPMs) are bioactive lipids derived from essential fatty acids that play a key role in resolving inflammation and modulating immune responses, thereby maintaining tissue homeostasis in various physiological contexts, including pregnancy. In healthy pregnancies, inflammation is a biological response necessary for vascular remodeling, embryo implantation as well as delivery and an increase in SPMs such as lipoxin A4 (LXA4) and resolvin D1 (RvD1) supports homeostasis and facilitates inflammation resolution. However, pregnancy complications such as spontaneous abortion, fetal growth restriction (FGR), and preeclampsia are often associated with disrupted SPM levels and receptor activity. In spontaneous abortion, altered SPM levels are linked to impaired endometrial receptivity, defective trophoblast invasion, poor epithelial-to-mesenchymal transition, and enhanced inflammation. Similarly, FGR is associated with reduced LXA4 levels, which contribute to placental vascular dysfunction and impaired trophoblast migration. Preeclampsia is characterized by dysregulated SPM levels and a pro-inflammatory environment, indicating insufficient resolutive activity. Therapeutic approaches to enhance SPM levels, such as aspirin-triggered lipoxins and omega-3 fatty acid supplementation, have demonstrated potential benefits. However, inconsistent clinical outcomes highlight the need for personalized treatment strategies. This review explores the role of SPMs in pregnancy, focusing on their molecular mechanisms and the development of targeted supplementation strategies to optimize their protective effects in managing high-risk pregnancies. KEY MESSAGES: Physiological pregnancies involve a gradual increase in SPM levels. LXA4 and RvD1 may have a context-dependent role in placentation by negatively regulating endometrial decidualization, trophoblast EMT and invasion, which contributes to spontaneous abortion, while positively regulating endothelial function, trophoblast survival and M2-macrophage polarization, which supports pregnancy. SPMs are essential to preserve endothelial integrity and support trophoblast proliferation, and appear downregulated in FGR. Preeclampsia is correlated with dysregulated SPM levels and a reduced LXA4/TNFα ratio, which suggests insufficient anti-inflammatory action. Therapeutic strategies that enhance SPMs production such as aspirin and DHA supplementation show considerable promise, particularly in preventing complications in high-risk pregnancies.