Significant advances have been made in the understanding, the management and the prevention of the major pregnancy complications. They have translated into gradually improving outcomes short term and long term for preterm born infants, prenatally growth restricted or large for gestational age infants. However, fetal growth restriction or exposure to maternal chronic disease, especially hyperglycemia in pregnancy, remain major challenges in the majority of countries of the world. Innovative, less invasive, family centered neonatal care has been implemented in many perinatal centers. The outcomes of the offspring of complicated pregnancies is becoming more and more dependent on the quality of prenatal care. Innovations in biotechnology, integration of patient generated big data and artificial intelligence are promising developments that will contribute to a better precision and personalization of neonatal care and follow-up.