Extracellular Vesicles: Emerging Roles in the Diagnosis and Management of Pregnancy-Related Disorders

Pregnancy is a complex and fine-tuned process, which requires accurate synchrony between the mother and the fetus. Extracellular vesicles, as released entities of the body, have drawn extensive interest as key messengers for such a dialogue system. These nanoparticle molecules, released from cells, can transport and deliver important biomolecules – such as proteins and nucleic acids – and take on deep regulatory roles during pregnancy – including at the implantation of the embryo and placental development, as well as in setting up the maternal–fetal immune environment. Meanwhile, outer membrane vesicles derived from the maternal microbiota are also information carriers in the maternal–fetal environment, and vesicles of both types form a highly complex vesicle-based signaling system. The vesicle composition and abundance are subject to change between healthy and pathological pregnancies, and they can thus be used as an “information window” into maternal and fetal health. The purpose of this chapter is to comprehensively review research advancements for different types of vesicles in physiological and pathological pregnancy, speculate on the specific mechanisms by which they are associated with pregnancy-related diseases, and evaluate them from clinical perspectives as emerging non-invasive diagnostic biomarkers and promising therapies for the future. Understanding how these vesicles are associated with pregnancy can promote early pregnancy diagnosis and could lead to future diagnostic or treatment methods.