Background: Preeclampsia is one of complications of pregnancy. It is responsible for morbidity for mother and fetus. Preeclampsia is a pregnancy multisystem disorder. Abnormal lipid profile has an effect on endothelial dysfunction. The association of serum lipid profile with preeclampsia is suggested to reflect new diagnostic tools. Pregnancy dyslipidemia is associated with an increased risk of preeclampsia. Compared to healthy pregnancy, women with preeclampsia have an abnormal lipid profile. Aim of the work: The aim of this work is comparison between normotensive women and preeclamptic women by serum lipid profile at third trimester. Patients and Methods: The present study conducted on 70 pregnant women in the Department of Obstetrics and Gynecology, at Al-Azhar University hospital [Damietta], which was conducted during 2019 [from April to December]. A study comprised 35 normotensive pregnant women as controls and 35 preeclampsia cases. The blood samples were analyzed for serum triglycerides [TGs], total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-C], lowdensity Lipoprotein-Cholesterol [LDL-C], very low-density Lipoprotein-Cholesterol [VLDL-C], Apo lipoprotein-A1 [Apo-A1] and Apo lipoprotein-B[Apo-B]. Results: There was significant difference between group A and B as regard Apo B/ Apo A1, cholesterol, TGS, LDL and VLDL. They are higher in group B. Conclusion: In the third trimester of pregnancy, preeclamptic women have altered levels of serum lipid profile. The most significant test is Apo B/A1 ratio with accuracy [72.7%].