〔Abstract〕 Objective To explore the predictive value of apolipoprotein (Apo) B/A1 ratio on adverse pregnancy outcomes in pregnant women with hypertensive disorders of pregnancy (HDP). Methods 100 pregnant women with HDP who underwent prenatal examination and delivered in Jinjiang Hospital of Traditional Chinese Medicine from August 2019 to August 2022 were selected as the observation group, and divided into good outcome group and bad outcome group according to the pregnancy outcome. Another 100 healthy pregnant women in the same period were included in the control group. Serum levels of ApoB and ApoA1 of pregnant women were measured by automatic biochemical analyzer, the ApoB/A1 ratio was calculated, and the predictive efficacy of ApoB/A1 ratio on adverse pregnancy outcome of HDP pregnant women was analyzed by receiver operating characteristic curve (ROC). Results Among the 100 HDP pregnant women, 58 cases had adverse pregnancy outcomes, the incidence was 58.00 %. Compared with control group, ApoB and ApoB/A1 ratio in the observation group were significantly increased, while ApoA1 was significantly decreased, the differences were statistical significance (P < 0.05). ApoB and ApoB/A1 ratio increased with the severity of HDP disease, among different types of diseases, the differences were statistically significant (P < 0.05). There was no significant difference in ApoA1 among all types of diseases (P > 0.05). ApoB and ApoB/A1 ratio in the poor outcome group were significantly higher than those in the good outcome group, and ApoA1 was significantly lower than that in the good outcome group, the differences were statistical significance (P < 0.05). ROC curve results showed that the AUC of ApoB/A1 ratio to predict adverse pregnancy outcome of HDP was 0.854, the cut-off value ≥ 0.675, the sensitivity was 96.55 %, the specificity was 61.90 %, and the Yoden index was 0.58. Conclusion ApoB/A1 ratio has high value in predicting adverse pregnancy outcomes in HDP patients.