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We investigated the relationship between early pregnancy plasma lipid concentrations and risk of preeclampsia.In a prospective cohort study, maternal blood samples were collected at an average of 13 weeks gestation. From the cohort, we selected 57 women who developed preeclampsia and 510 who remained normotensive and served as control subjects. Plasma lipid concentrations were measured enzymatically by standardized assays. Logistic regression procedures were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI).Women who subsequently developed preeclampsia had 10.4%, 13.6%, and 15.5% higher concentrations of LDL cholesterol, triglycerides, and LDL/HDL ratios, respectively, than did control subjects (P < .05). The HDL cholesterol concentrations were 7.0% lower in women with preeclampsia than in control subjects (P < .05). After adjustment, there was a 3.60-fold increase in risk of preeclampsia among women with total cholesterol >205 mg/dL (95% CI 1.23 to 10.51) and a 4.15-fold increase in the risk of preeclampsia among women with triglyceride levels >133 mg/dL (95% CI 1.50 to 11.49). A linear increase in preeclampsia risk was observed with increasing tertiles of LDL cholesterol, triglyceride concentrations, and LDL/HDL ratio (all P < .05 for trend).Early pregnancy dyslipidemia is associated with an increased risk of preeclampsia. This association may be significant in understanding the pathologic processes of preeclampsia and may help in developing strategies for prevention or early diagnosis of the disorder. Am J Hypertens 2004;17:574-581 © 2004 American Journal of Hypertension, Ltd.