Introduction: Hypertensive disorders of pregnancy (HDP), including preeclampsia and gestational hypertension, remain major contributors to maternal and perinatal morbidity and mortality. Early identification of women at risk is critical to improving outcomes. Dyslipidemia during pregnancy has been proposed as potential predictive marker for HDP, with abnormal lipid metabolism contributing to endothelial dysfunction, vascular injury, and hypertension. This study aimed to evaluate whether serum lipid profile assessed between 14–20 weeks of gestation can predict development of HDP.

Material and Methods: A prospective observational cohort study was conducted in the Department of Obstetrics & Gynaecology, SMS Medical College, Jaipur, from October 2023 to May 2024. A total of 242 pregnant women between 14–20 weeks of gestation were enrolled after applying inclusion and exclusion criteria. Fasting venous blood samples were collected to assess lipid parameters (total cholesterol, triglycerides, HDL, LDL, and VLDL). Participants were followed until delivery for development of HDP. Data were analyzed using SPSS v23, with chi-square tests, t-tests, ANOVA, and ROC curve analysis applied.

Results: Of 242 women, 36 (14.87%) developed HDP. Among them, 12.40% had abnormal lipid profiles. Elevated total cholesterol was significantly associated with HDP (202.35 ± 52.48 vs. 172.82 ± 29.64 mg/dL, p=0.0001). Triglycerides, VLDL were higher in HDP cases but did not reach statistical significance. Total cholesterol showed highest diagnostic accuracy (80.12%), with specificity of 83.95%. Maternal age also significantly correlated with HDP risk, with higher prevalence in women >28 years.