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Leili Mohebnasab: Why Pregnancy Was Never Designed to Be Easy
Leili Mohebnasab/LinkedIn
Dec 22, 2025, 16:31

Leili Mohebnasab: Why Pregnancy Was Never Designed to Be Easy

Leili Mohebnasab, Midwife at Shariati Hospital, shared a post on LinkedIn:

“Evolutionary Obstetrics and Immunology:

Why Pregnancy Was Never Designed to Be Easy

Pregnancy is often described as a fragile state – one that requires constant medical vigilance.

But from an evolutionary perspective, pregnancy is something far more complex: a biological compromise shaped by survival, reproduction, and trade-offs across thousands of generations.

According to WHO (2024), NIH evolutionary biology frameworks, and FIGO maternal – fetal science reviews, the immune system in pregnancy is not ‘suppressed.’

It is strategically reprogrammed.

Why tolerance exists at all

Human pregnancy involves a deeply invasive placenta and a semi-allogeneic fetus. Complete immune rejection would end reproduction.

Evolution’s solution was not immune silence – but controlled tolerance, mediated by Tregs, decidual NK cells, and unique placental signaling.

Why complications are common

From an evolutionary lens, conditions like preeclampsia and preterm birth are not design flaws – they are byproducts of trade-offs:

  • larger fetal brains,
  • deeper placental invasion,
  • high maternal metabolic demand.

Human birth sits at the edge of what biology can safely sustain.

Why the system is dynamic, not stable

Pregnancy immunity shifts by trimester because the evolutionary pressures change:

  • implantation requires tolerance,
  • mid-gestation favors growth,
  • late pregnancy reactivates inflammation to initiate labor.

This is not pathology. It is timing.

A midwifery perspective

Understanding pregnancy through evolution reframes care.

It explains why ‘perfect’ pregnancies are rare, why complications cluster around the placenta, and why vigilance – not blame – is essential.

Pregnancy was never designed to be easy.

It was designed to be possible.

WHO | NIH | FIGO (2024–2025)

Question for you

If pregnancy complications reflect evolutionary trade-offs rather than failure, how should that change the way we counsel and care for pregnant people?”

Read more.

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