There is considerable variation in the expression of severe preeclampsia. Our purpose was to determine if this is associated with maternal race or ethnicity. Study design: Individual chart review was performed for women diagnosed with severe preeclampsia at a tertiary care center from 1993 to 2003. Demographic, clinical, and lab findings from diagnosis (Dx) to 6 weeks’ postpartum (PP) were documented. Data were compared between Caucasian, African American, and Hispanic women. Data were presented for the total cohort if no significant difference was found. Results: We evaluated 473 pregnancies: 201 (Caucasian), 216 (African American), and 56 (Hispanic). Groups had similar baseline characteristics: chronic hypertension (HTN), diabetes, and initial antenatal blood pressure (mean BP 118/68). Caucasian women were older (27 vs 24 yrs), more likely nulliparous (63 vs 49% ), and had more multiple gestations (9 vs 1.5% ), P < .002 for each. African Americans had less epigastric pain (7.4 vs 10% ) and nausea (2.3 vs 5% ), P < .05 for each. Platelets < 100,000/μ L and asparate aminotransferase >60 mg/dL were more common in Caucasian women at Dx (9 vs 12% , 11 vs 21% ) and at delivery (14 vs 24% , 19 vs 34% ), P < .05 for each. No difference in severe proteinuria was seen. African Americans had more severe HTN at both Dx (44.9 vs 30% ) and peak BP (85 vs 67% ), and required more antihypertensive Rx intrapartum (12 vs 6% ), PP (38 vs 12% ), and at discharge (35 vs 21% ), P < .03 for each. Hispanics presented later (36 vs 34.6 weeks) and had less severe HTN (27 vs 40% ), P < .04 for each. BP on DC was not different between groups. Caucasian women had more hemolysis, elevated liver enzymes and low platelets syndrome (29 vs 19% , P = .01). Eclampsia, intrauterine fetal demise, intrauterine growth restriction, abruption, PP preeclampsia, and recurrent preeclampsia were similar between groups. Conclusion: African American women with severe preeclampsia demonstrate more severe hypertension and required more antihypertensive Rx, while Caucasian women have more frequent hemolysis, elevated liver enzymes and low platelets syndrome. There is considerable variation in the expression of severe preeclampsia. Our purpose was to decide if this is associated with maternal race or ethnicity. Study design: Individual chart review was performed for women diagnosed with severe preeclampsia at a tertiary care center from 1993 to 2003. Demographic, clinical, and lab findings from diagnosis (Dx) to 6 weeks’ postpartum (PP) were documented. Data were compared between Caucasian, African American, and Hispanic women. Data were presented for the total cohort if no significant difference was found. Results: We as 473 pregnancies: 201 (Caucasian), 216 (African American), and 56 (Hispanic). Groups had similar baseline characteristics: chronic hypertension (HTN), diabetes, and initial antenatal blood pressure (mean BP 118/68) African women had less epigastric pain (7.4 vs 49%), and had more multiple gestations (9 vs 1.5%), P <.002 for each. African women had less epigastric pain (7.4 vs 49 yrs), more likely nulliparous 10% ) and nausea (2.3 vs 5%), P <.05 for each. Platelets <100,000 / μL and asparate aminotransferase> 60 mg / dL were more common in Caucasian women at Dx (9 vs 12%, 11 vs 21%) and at delivery (14 vs 24%, 19 vs 34%), P <.05 for each. No difference in severe proteinuria was seen. African Americans had more severe HTN at both Dx (44.9 vs 30%) and peak BP (85 vs 67%), and required more antihypertensive Rx intrapartum (12 vs 6%), PP (38 vs 12%), and at discharge (35 vs 21%), P <.03 for each. Hispanics presented later (36 vs 34.6 P <.04 for each. BP on DC was not different between groups. Caucasian women had more hemolysis, elevated liver enzymes and low platelets syndrome (29 vs 19%, P = .01). Eclampsia, intrauterine fetal demise, intrauterine growth restriction, abruption, PP preeclampsia, and recurrent preeclampsia were similar between groups. Conclusion: African American women with severe preeclampsia demonstrate more severe hypert ension and required more antihypertensive Rx, while Caucasian women have more frequent hemolysis, elevated liver enzymes and low platelets syndrome.