Prediction rules can contribute to more efficient and effective care. Outcome may be altered by interventions to mitigate upcoming modifiable risk factors, or when risks are caused by non-modifiable factors, extra personalized caution. Prognosis can be based on population-based risk prediction or individualized risk prediction. Clinically, we routinely rely on population-based risk, even though for the individual patient, population-based risk measures often prove to be insensitive. In contrast to population-based risk evaluation, individualized risk prediction varies from person to person and is shaped by the individual’s profile, usually based on a multi-marker prediction model. Most prediction models for pre-eclampsia use predictors such as medical history, body mass index, blood pressure, parity, uterine artery pulsatility index (uaPI) and maternal age. Apart from blood pressure and gestational uaPI, none included central haemodynamic measures, including key players’ blood flow, composition and vessel wall characteristics. Individualized prevention of pre-eclampsia or attenuated fetal growth can be reached by determination and targeted correction of non-physiological normogram-guided care, reducing the risk of pre-eclampsia by about half (OR 0.5 (95%CI 0.27–0.92), number needed to treat NNT 9) and HELLP syndrome by 90% (OR 0.09 (95%CI 0.01–0.75), NNT 18) without negatively affecting fetal growth (OR 0.75 (95%CI 0.38–1.46), NNT 31). Non-individualized risk reduction can be reached by preventive use of aspirin (RR 0.79 (95%CI 0.72–0.82)), calcium (>1 g/day, RR 0.42 (95%CI 0.18–0.96)) and low molecular weight heparins (RR 0.57 (95%CI 0.36–0.90)), especially when combined with aspirin. Effective preventive dietary interventions may be in reducing salt intake (high salt intake >6 g/day associated with pre-eclampsia hazard ratio 5.68 (95%CI 1.51–21.36)), adequate consumption of vegetables (RR 0.38 (95%CI 0.18–0.80), fruits (RR 0.42 (95%CI 0.24–0.71)), fish and whole grains (RR 0.58 (95%CI 0.42–0.81)), while reducing intake of refined grains, high fat foods and processed meats (0.25 (95%CI 0.09–0.69)) reduces the risk of hypertensive vascular complications in pregnancy. Finally, aerobic exercise during pregnancy substantially lowers the risk of gestational hypertensive disease (physical activity for 1–4 days per week: OR 0.63 (95% CI: 0.45–0.90); physical activity for 5+ days per week: OR 0.46 (95% CI: 0.20–1.02)). As such, targeted care, tracking healthy gestational adjustments, generic and targeted medical interventions and lifestyle interventions all may contribute to the prevention of vascular complicated pregnancy.