It is easy for a crystal ball to predict that the future will include enhanced technology, i.e. digital medicine, higher resolution ultrasound, etc; novel biomarkers, including both genomic and proteomic markers, that can be used to predict disease risk or evaluate disease status; and expansive data repositories containing patient data, physician notes and patient reported outcomes and the lifetime histories of the mother and father. And ideally these will all be accessible using a Star Trek Tricorder! The critical question remains, however, will we have improved the care and outcome for our patients? Do we carry out adequate research on normal and abnormal developmental systems and processes, and if not, why? Are the gaps in funding or in adequately translating from "unstated" unmet clinical needs, i.e. what we may deal with based on clinical experience, to researchers whose committed efforts therefore may or may not address the problems at hand? We want to predict who is at risk for pre-eclampsia or preterm birth, but do these conditions reflect a level of heterogeneity that needs to be discussed so that more accurate diagnoses and treatments can be developed? If we collect "all of the data", can we move beyond prediction, i.e. correlative analysis, to causal analysis so that we might not only know when a patient is "headed" but potentially how/where/when we might be able to intercede in that progression? And do we adequately consider differences among those characteristics that differ among population groups? To best envision the future, and impact how it comes about, we should start with better understanding where we are today.