Sharper focus on uncomplicated pregnancy

Many studies have identified factors associated with complications of pregnancy, such as maternal age, ethnicity, obesity, smoking, and pre-existing medical conditions.1 2 3 In a linked paper (doi:10.1136/bmj.f6398), Chappell and colleagues take the opposite approach and use information from a large cohort of nulliparous women in Australia and the United Kingdom to investigate factors associated with uncomplicated pregnancy.4 This robust approach is welcome in the context of initiatives to step back from the medicalisation of pregnancy and provides useful information for women, clinicians, and policy makers.

The authors divide factors associated with uncomplicated pregnancy into those that they consider modifiable—such as raised body mass index, drug misuse before pregnancy, and fruit intake before pregnancy—and those considered not amenable to change, including a family history of hypertension and maternal socioeconomic index. The study is observational and we cannot assume causality, so replication in similarly robust studies may be needed before we consider interventions to help change these modifiable factors. Nevertheless, it is clear that these factors will not be modified by actions during pregnancy alone. Public health …