The Role of Biomechanical Regulation in Physiological and Pathological Pregnancy: From Mechanotransduction to Clinical Implications.

Pregnancy is a highly coordinated process that relies on the precise regulation of the extracellular matrix, cells, and various molecules at the maternal-fetal interface. As the fetus grows and amniotic fluid increases, the uterus undergoes adaptive remodeling, a process in which biomechanics plays an indispensable role. This review aims to systematically explore the biomechanical characteristics of the uterus and specifically elucidate the crucial regulatory roles of mechanical signals such as stiffness, shear stress, tension, and compression force in both physiological and pathological pregnancies. We focus on the remodeling of the extracellular matrix, the mechanical property changes of the maternal-fetal interface, and the associated mechanotransduction pathways, such as PIEZO1, integrins, and YAP/TAZ. Finally, we summarize the cutting-edge technologies used to investigate uterine biomechanics and discuss the clinical translational potential of targeting mechanical signaling pathways as novel diagnostic and therapeutic strategies for pregnancy complications. This review provides a comprehensive analysis of how biomechanical cues regulate uterine function at the molecular, cellular, and tissue levels.