The recent article by Lisonkova and Joseph found an increased risk of preeclampsia in African Americans for early-onset and diabetes for late-onset preeclampsia, as well as an overall increased risk in Hispanics and Native Americans and a marked increase as gestation approaches term. The authors found that an increased body mass index was associated with an increased risk of early preeclampsia, but did not emphasize the issue of weight on the risk of preeclampsia. It is predictable that there would be an increased severity of preeclampsia and poor fetal outcomes in early gestation, which may be a problem secondary to the effects of obesity leading to early-onset disease. It is my hypothesis that preeclampsia is secondary to an increased intraabdominal pressure (IAP), which reduces venous flow from the uterus/placenta and throughout the body. A prior study has documented an increased IAP in women with central obesity. Many of the phenomena found in this study could be related to that problem, as diabetes is often seen in obese women and obesity is a major problem in Hispanics, Native Americans, and African Americans as compared to Caucasians and, clearly, there would be an increased IAP as pregnancy approaches term. The smooth rate of increased risk of preeclampsia noted by Lisonkova and Joseph supports this concept and argues against >1 etiology for early vs late preeclampsia. There are several studies showing that the risk of preeclampsia decreases profoundly after surgically induced weight loss. I am currently conducting a study to determine if lowering the IAP will reverse the pathophysiology of preeclampsia.