OBJECTIVE: Clinical trials have confirmed the association of metabolic syndrome with cardiovascular disease ( CVD) in women. Because recent evidence suggests that preeclampsia is a risk factor for future CVD, we sought to determine whether metabolic syndrome was associated with preeclampsia. STUDY DESIGN: As part of a large case- control study, women were prospectively identified with preeclampsia. Controls were patients presenting for delivery at term without preeclampsia. Two pregnancy-based metabolic scores ( 0, 1, or 2 or more) were created using initial or final pregnancy body mass index, chronic hypertension, and diabetes. Stratified analysis and logistic regression were used to evaluate the association of metabolic score with preeclampsia and disease severity. RESULTS: For initial metabolic score, 44.1%, 42.3%, and 13.5% of cases ( n = 259) and 61.5%, 33.2%, and 5.3% of controls ( n = 297) had scores of 0, 1 ( odds ratio [ OR] 1.91, P =.002), and 2 or more ( OR 2.65, P =.001), respectively. CONCLUSION: Metabolic score appears to be associated independently with developing preeclampsia, particularly severe disease.