There is clinical and ultrasonographic evidence that "abnormal fetal-maternal interactions" or "fetal-maternal conflicts" may be central to the mechanisms of injury in pregnancy complications such as fetal growth restriction, preeclampsia, fetal death, gestational diabetes, and a subset of patients with preterm parturition. This conceptual framework integrates abnormalities in the placental bed, placental vasculature, and other areas of fetal-maternal interactions with pregnancy complications in light of their possible evolutionary value.