Pre‐eclampsia remains a major burden of disease, accounting for approximately 50,000–70,000 maternal deaths each year worldwide. Frustratingly, the management of pre‐eclampsia has remained essentially unchanged for much of the last century and focussed primarily on maternal blood pressure control to allow fetal maturation. Recent advances in the understanding of the pathogenesis of pre‐eclampsia and the elucidation of distinct underlying mechanisms offer the genuine prospect of new and effective therapies that may transform outcomes for millions of women and their babies.