The two lead articles in this issue of ANZJOG deal with major maternal problems that adversely affect perinatal outcome, namely obesity and alcohol consumption. I have chosen to lead with an excellent review of maternal obesity and reproductive outcomes. The obesity epidemic that is affecting most of the developed world and even some developing countries means that, in Australia, nearly 50% of the population is now considered to be either overweight or obese. This will, of course, translate into a proportion of women of reproductive age being at least overweight when they begin their first pregnancy, or in some cases frankly obese. The almost inevitable tendency to increase weight in pregnancy and between pregnancies means that for some they are morbidly obese by the time they are pregnant for the second or third time. Coupled with the rapidly rising caesarean section rate (higher in overweight women for reasons that may be partly explained by fetal size and poor myometrial contractility), this leads to the surgical nightmare of repeat caesarean section in difficult circumstances, sometimes with the additional problem of a placenta praevia and/or accreta. The case report from Vanuatu at the end of this issue is a simple reminder of other possible surgical complications. Interventions during pregnancy to alleviate this problem are currently being trialled, but I think it is unlikely that anything will lead to dramatic weight loss in pregnancy, sufficient to radically change outcomes. Surely primary prevention has to be the key and the stark message needs to be delivered as part of pre-pregnancy planning that maternal obesity is a significant risk to the well-being of both mother and baby. A better understanding of the childhood and adolescent origins of this problem must surely be of help in dealing with this problem. There is still no real consensus around the world on what constitutes safe maternal alcohol consumption in pregnancy. The article by Elliott and Bower is an invited editorial on the current state of knowledge about the effects of alcohol in pregnancy, and what obstetricians are doing about it. Although many of us will only rarely see the features of full-blown fetal alcohol syndrome (FAS), there are other more subtle manifestations and a better understanding of the effects of lower level alcohol intake is vital. Caroline de Costa's original article describing the pregnancy characteristics of mothers whose babies were diagnosed with FAS in North Queensland is a sobering contribution to the debate. Given that many pregnancies are not planned, this suggests that there is further scope for pre-pregnancy educational interventions that alert young women to the dangers. Perhaps this should be another focus of the recent federal government's initiative to tackle the problem of binge drinking among young adults. This issue we welcome some new members to the Editorial Board: Jodie Dodd (Adelaide) brings to our team her considerable expertise in randomised trial design; Jonathon Morris (Sydney) will deal primarily with some of the contributions on laboratory-based research in pregnancy; Peter Dietz has many areas of interest but brings expertise in the use of ultrasound as a research tool, as well as his subspeciality field of urogynaecology; and Neil Johnson (Auckland) ensures there is still some representation on the Board from New Zealand, as well as bringing his own set of skills in the gynaecological field. This is all part of the process of refreshing and expanding the Board. Recently retired from the Board are four members who have all contributed enormously over the last five years or so. Caroline Crowther, Euan Wallace, Michael Quinn and Cindy Farquhar are all stepping down and I would like to publicly acknowledge their hard work over a significant period of time. Other additions to the Board will be announced in due course. Of course, our associate editors cannot do their work without the willing help of our reviewers. As a relatively small population across our two countries, the group of reviewers is also quite small with only one or two expert reviewers in some specialised areas. I realise that many of you are called upon to perform the same task for other higher profile international journals. Nevertheless, it is important that we all pull together to improve the quality of our own local journal, in which some of our young investigators publish their first papers at what may be the beginning of a reputable academic career. In my short time in this role, I do believe I have seen an overall improvement in both the quantity and the quality of contributions to ANZJOG, and some of these are from our trainees. It will be interesting to see if this is reflected by the impact factor in due course.
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