Background Spinal anesthesia-induced maternal hypotension is the most frequent complication associated with maternal morbidity and mortality during cesarean section. The aim of this study was to compare the incidence and magnitude of hemodynamic changes in preeclamptic and non-preeclamptic parturients undergone cesarean section under spinal anesthesia. Method A prospective cohort study was conducted from February to May 2019 in University of Gondar comprehensive specialized hospital. A total of 122 ASA II and ASA III parturients were recruited consecutively and assigned to two groups (81non-preeclamptics, and 41 preeclamptics). The data analysis was done by SPSS version 22 statistical software. The data were tested for normality with Shapiro Wilk U-test and normally distributed data were compared by using the independent student’s t-test. Whereas non-normally distributed data were compared using the Mann-Whitney U- test. Fisher’s exact test was used for intergroup comparison of proportion. All P values <0.05 were considered statistically significant. Result The incidence of spinal anesthesia-induced hypotension was higher in non-preeclamptic parturients than preeclamptic parturients (55.6% vs. 34.1%, respectively) and the degree of blood pressure drop was significantly greater in the non-preeclamptic parturients compared to those with preeclampsia; As well intraoperative fluid consumption was significantly greater in the non-preeclamptics parturients compared to those with preeclamptics. Conclusion The incidence and magnitude of spinal anesthesia-induced hypotension in parturients undergone cesarean section were less in preeclamptic parturients than in non-preeclamptic parturients. Therefore, don’t deny spinal anesthesia for preeclamptic parturients due to fear of profound hypotension, unless there is a contraindication for spinal anesthesia.