<p>Pregnancy is a complex and dynamic process, immune homeostasis at the maternal-fetal interface is one of the keys to a successful pregnancy and essential for fetal nutrient exchange and the establishment of immune tolerance. Healthy pregnant women with normally functioning immune systems can successfully maintain a semi-allogeneic fetus to full term without immune-mediated rejection, many immune cells including macrophages, NK cells, T cells, B cells and dendritic cells are involved in this process. In particular, macrophages play a vital role in the establishment of immune tolerance, infection prevention, spiral artery remodeling, and overall maternal and fetal health, due to their plasticity and diversity. However, environmental toxins like endocrine-disrupting chemicals (EDCs) can impact macrophage function, leading to pregnancy-related conditions. This review explores the current knowledge of macrophages at the maternal-fetal interface, their roles in pregnancy, and how EDCs affect their polarization and function.</p>