A study of the fundamental biology of the maternal-fetal interface reveals the complex interactions among multiple cell types and regulatory factors necessary to support a successful pregnancy. Cells of decidua and trophoblast lineages play central roles in creating the maternal-fetal interface and are sources of regulatory factors that can determine the quality and success of pregnancy. The regulatory factors considered here are major placental histocompatibility complex proteins, pregnancy-specific regulatory factors for uterine inflammatory cells, and hormone-controlled placental multidrug-resistant transport systems. Potential targets are discussed and presented as areas where researchers may identify novel pharmacological and immunological strategies that eventually will extend to the clinic to improve the quality and success of pregnancy.The milieu comprising the complex maternal-fetal interface is normally a precisely choreographed interplay among multiple cell types and regulatory factors that results in the immunologically safe and nurturing surroundings required to support growth and development of the embryo and fetus. Generally, two cell lineages, decidua and trophoblast, are involved in both secretion of and responses to several regulatory factors that modify the maternal-fetal interface surroundings to create the necessary conditions and anatomical structures to protect the mother and the fetus. The regulatory factors include chemokines, cytokines, growth factors, antigens, and hormones. On occasion, cell secretions of regulatory factors or responsiveness to these regulatory factors are disrupted with the ultimate consequences being pregnancy termination, or intrauterine growth retardation, or potentially maternal compromise. As a consequence, characterization of the fundamental biology of the maternal-fetal interface should expose new targets for therapeutic interventions appropriate to protect mother and fetus.This perspective considers the roles of decidual and trophoblast cells as sources of major placental histocompatibility complex proteins and their influence on maternal inflammatory and immune cell responses, pregnancy-specific regulatory factors for uterine inflammatory cells, and hormoneregulated placental multidrug-resistant transport systems. Although representing three distinct areas, each represents a major player as a protective mechanism for the mother and the fetus. It is clear, for example, that human leukocyte antigens (HLAs) and pregnancy-specific regulatory factors enable the maternal immune system to change and cope with pregnancy and protect the fetal-maternal interface from immune disorders. Based on an understanding of these functions, interventions might someday be developed that enable mothers prone to immune disorders to avoid conditions reThe studies in the laboratory of Dr.