Artificial wombs in perinatal medicine: a transformative frontier in neonatal care and bioethics

Abstract

Objectives: To evaluate the current state and translational readiness of artificial womb technology (AWT), focusing on its technical feasibility, preclinical validation, and ethical, legal, and clinical implications for perinatal medicine. Methods: We conducted an integrative narrative review of the scientific literature from January 2000 to May 2025. Searches were performed in PubMed, Scopus, and Web of Science using terms such as “artificial womb,” “extrauterine fetal incubation,” “artificial placenta,” “preterm birth,” and “bioethics.” A total of 65 peer-reviewed studies were included, spanning domains of bioengineering, preclinical models, clinical frameworks, and normative analysis. Data were synthesized thematically, with supplemental visual mapping and comparative tables to illustrate platform characteristics and ethical considerations. Results: Advanced AWT systems, including EXTEND and the Perinatal Life Support (PLS) platform, have demonstrated success in sustaining extremely preterm lambs and goat fetuses, preserving physiological development in fluid-based environments. Key innovations include pumpless oxygenators, modular system architecture, and AI-assisted monitoring. Despite progress, unresolved challenges include umbilical cannulation, sterility, endocrine simulation, and long-term neurodevelopmental outcomes. Ethical tensions surround maternal autonomy, fetal personhood, informed consent, and global equity in access. Conclusions: Artificial wombs represent a paradigm shift in neonatal care, offering the potential to extend viability and reduce preterm morbidity. As AWT approaches clinical translation, interdisciplinary coordination across medicine, ethics, and law will be essential to guide responsible integration. This analysis provides a foundational roadmap for advancing AWT from preclinical innovation to ethical clinical application.