Pre-eclampsia is a major cause of maternal morbidity and mortality, although partly preventable with effective primary care. Low-risk prenatal care enables early risk assessment, recognition of warning signs, and timely preventive measures such as low-dose aspirin and calcium. Understanding the epidemiological profile of affected women helps identify care gaps and guide improvements in primary care.To describe the clinical and epidemiological profile of pregnant women with pre-eclampsia in a tertiary hospital and identify gaps in prevention and risk stratification that should begin in primary care.This was a cross-sectional, retrospective, quantitative study based on medical records from a tertiary maternity hospital (XXX), from January 2023 to December 2024. Among 2,764 medical records reviewed, 200 had confirmed pre-eclampsia; of these, 89 were selected using sample size calculation. Sociodemographic variables, obstetric history, comorbidities, medication use, and complications were analyzed. Statistical analyses included descriptive statistics, Spearman correlations, Mann–Whitney U tests, and a classification tree to identify predictors of complications.The mean age was 31.5 years, and 63% of participants resided in the study area. Hypertensive disorders during pregnancy were prevalent: 78.7% had gestational hypertension and 21.3% chronic hypertension. HELLP syndrome occurred in 6.74% of cases—higher than expected in the general population—and was significantly correlated with imminent eclampsia (r = 0.320; p = 0.002). The classification tree identified age between 17 and 29 years and marital status as relevant predictors of complications. Previous obstetric events were common but showed no statistical significance.The findings show a profile of young women with metabolic comorbidities and social vulnerability—factors to be identified and managed early in primary care. The association between HELLP syndrome and imminent eclampsia highlights the need for timely recognition of severe warning signs. The higher complication rate among younger women challenges the focus on advanced maternal age, suggesting a key role of social determinants and adherence.This study highlights the need to strengthen prenatal care in primary care, emphasizing risk stratification, preventive measures, multidisciplinary follow-up, and attention to young, socially vulnerable women to reduce hypertensive complications and maternal morbidity. MeSH: Pre-Eclampsia; Primary Health Care; Prenatal Care; Hypertension, Pregnancy-Induced