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Background: Preeclampsia is a pregnancy-specific hypertensive disorder and a major contributor to maternal and perinatal morbidity worldwide. Emerging evidence suggests that dysregulated lipid metabolism plays a key role in its pathophysiology. Atherogenic lipid ratios, particularly triglyceride to high-density lipoprotein (TG/HDL) and low-density lipoprotein to high-density lipoprotein (LDL/HDL), may provide better predictive value than individual lipid parameters. However, evidence from South Asian populations remains limited. This study evaluated the association between atherogenic lipid ratios and the severity of preeclampsia among pregnant women in Eastern India. Methods: A prospective observational comparative cohort study was conducted at Rampurhat Government Medical College, West Bengal, India, from May 2023 to November 2024. A total of 180 pregnant women (≥20 week’s gestation) were enrolled and categorized into three groups: normotensive controls (n=60), mild preeclampsia (n=60), and severe preeclampsia (n=60). Fasting lipid profiles, including total cholesterol, triglycerides, LDL-C, and HDL-C, were measured using standard enzymatic assays. Atherogenic lipid ratios (TG/HDL and LDL/HDL) were calculated. Statistical analyses included one-way ANOVA, Pearson correlation, multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis to assess predictive performance. Results: Women with preeclampsia exhibited significantly higher triglycerides and LDL-C levels and lower HDL-C levels compared with normotensive controls (p<0.001). The TG/HDL ratio increased progressively from controls (2.09) to mild preeclampsia (2.97) and severe preeclampsia (3.73), while the LDL/HDL ratio increased from 1.44 to 2.28 across the groups (p<0.001). The TG/HDL ratio showed a strong positive correlation with systolic (r=0.87) and diastolic blood pressure (r=0.85). Multivariate logistic regression identified TG/HDL as an independent predictor of pregnancy-induced hypertension (p=0.013). ROC curve analysis demonstrated excellent diagnostic performance for TG/HDL ratio (AUC=0.97). Conclusions: Atherogenic lipid ratios, particularly TG/HDL, are strongly associated with the presence and severity of preeclampsia and may serve as reliable, low-cost biomarkers for early risk stratification in pregnancy. Incorporating these ratios into routine antenatal screening could improve early identification of high-risk women and support timely clinical intervention. Key words: Preeclampsia, Atherogenic lipid ratios, TG/HDL ratio, LDL/HDL ratio, Dyslipidemia, Pregnancy-induced hypertension.