During pregnancy, uterine smooth muscle (USM) coordinately adapts its contractile phenotype in order to accommodate the developing fetus and then prepare for delivery. Herein we show that SMTNL1 plays a major role in pregnancy to promote adaptive responses in USM and that this process is specifically mediated through interactions of SMTNL1 with the steroid hormone receptor PR-B. In vitro and in vivo SMTNL1 selectively binds PR and not other steroid hormone receptors. The physiological relationship between the two proteins was also established in global gene expression and transcriptional reporter studies in pregnant smtnl1 ؊/؊ mice and by RNA interference in progesterone-sensitive cell lines. We show that the contraction-associated and progestin-sensitive genes (oxytocin receptor, connexin 43, and cyclooxygenase-2) and prolactins are down-regulated in pregnant smtnl1 ؊/؊ mice. We suggest that SMTNL1 is a bifunctional co-regulator of PR-B signaling and thus provides a molecular mechanism whereby PR-B is targeted to alter gene expression patterns within USM cells to coordinately promote alterations in USM function during pregnancy.Uterine smooth muscle (USM) 5 cells show a high degree of plasticity and are capable of transforming their phenotype in response to a variety of physiological stresses, such as pregnancy. In pregnancy, USM cells go through a number of extensive phenotypic changes characterized by the expression of a distinct set of proteins (1, 2). In early pregnancy, USM cells proliferate rapidly under the influence of endocrine-stimulated growth factors (3). A significant increase in the expression of anti-apoptotic factors is a key feature of this proliferative phase (4). In midpregnancy, USM cells switch into a synthetic phase characterized by cellular hypertrophy, extracellular matrix remodeling, and activation of apoptotic pathways (3). The changes that occur during this phase are under the influence of both mechanical stimuli and endocrine hormones, such as progesterone (2). Toward parturition, the cells adopt a more contractile phenotype, characterized by an up-regulation in the expression of contraction-associated proteins (CAPs) (2). The phenotypic changes in this phase are modulated by mechanical stimuli and sex-related hormones, such as progesterone and estrogen. The molecular mechanisms regulating the transition of the USM through these different stages are limited, and investigation of these mechanisms is of great importance given the fact that preterm labor is still the leading cause of neonatal morbidity and mortality (5, 6).USM contraction is mainly regulated by phosphorylation of the regulatory light chain of myosin (MLC20) by Ca 2ϩ /calmodulin-dependent myosin light chain kinase, whereas relaxation is promoted by dephosphorylation of MLC20 by myosin phosphatase (7,8). Both myosin light chain kinase and myosin phosphatase are regulated by several accessory proteins, and one such protein is smoothelin-like protein 1 (SMTNL1) (9). Mouse SMTNL1 is divided into two separate domains: a uniqu...