The “political” enthusiasm for women to have more babies will not come without a downside. Complications such as pre-eclampsia — a major cause of premature delivery — are likely to become more prevalent as increasing numbers of women become pregnant when they are older or obese, and may affect up to 5% of these women. The reason why pre-eclampsia develops is an enigma. Although there have been no recent major advances in the clinical treatment of this diverse disorder, maternal and fetal outcomes in Australia and New Zealand are good.1 The big risk now is that obstetricians, physicians, general practitioners and midwives will become complacent about the management of these high-risk pregnancies.