Preeclampsia (PE) is a pregnancy disorder characterized by hypertension and end-organ damage. Reliable biochemical markers for diagnosis and prediction of PE severity can improve maternal health, and several of these markers have been suggested till now. The goal of our study was to evaluate maternal serum levels of Perlecan and Ischemia modified albumin (IMA) in PE patients, and to investigate their relationship with the severity. This study included 45 pregnant women, who were divided into three groups: mild PE (n=15), severe PE (n=10), and normal pregnant females (n=20) as a control group. Maternal serum levels of Perlecan and IMA were determined by the enzyme linked immunosorbent assay (ELISA). Preeclamptic women with severe features have significantly higher serum Perlecan and IMA levels than women with mild PE and control (P<0.001 for both). Serum levels of Perlecan and IMA were significantly increased in patients with mild PE as compared with control (P<0.001 for both). Serum Perlecan levels were positively correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), ALT, AST, creatinine, urea, uric acid, and proteinuria, but negatively correlated with platelet count and fetal birth weight. Serum IMA level was positively correlated with SBP, DBP, but negatively correlated with Albumin, and fetal birth weight. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of Perlecan and IMA in the prediction of PE severity. Serum Perlecan had greater sensitivity and lower specificity for severe PE than for mild PE. Serum IMA had greater sensitivity and lower specificity for severe PE than for mild PE. In conclusion, maternal serum Perlecan and IMA levels were biomarkers for monitoring PE and the increase in serum Perlecan levels was in accordance with the severity of PE. Also, Perlecan was superior to IMA as a predictor for PE severity.