Maternal health and infant health are inextricably linked. Fetal development is dependent on a healthy in utero environment, which is influenced by the mother’s health and her associated environmental stressors. Furthermore, healthy mothers are needed to care for infants after birth. Thus, to improve infant health and reduce infant mortality, we must optimize maternal health. Ultimately the health of infants and children are a critical foundation for adult health and overall population health. Policies and interventions to improve maternal health are essential for population health as they will pay future dividends for maternal and infant health.

Without healthy mothers, we will not have healthy infants. During the prenatal period, pregnancy-related disorders are risk factors for worse infant outcomes, including infant mortality. In this issue of Pediatric Research, Yurkiw et al. report twofold greater odds of mortality in preterm (<29 week gestation) twin infants born to mothers with hypertensive disorders of pregnancy, compared to those born to normotensive mothers. Two basic questions arise: (1) How does this happen? and (2) Why does this happen? The cellular pathways by which hypertensive disorders of pregnancy affect infant health capture only one part of the problem, answering the “how” of the pathophysiology. A more daunting aspect of the problem begs to know “why”? Why did the mothers of these infants develop hypertension? If we know the “why” there is potential to develop approaches for prevention, which is important to improve maternal health and infant health outcomes.

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