Preeclampsia is a complex pathophysiological state where regulatory systems of inflammation and endothelial function are stimulated beyond the physiological limits of normal pregnancy. Different lines of evidence indicate that abnormal lipid metabolism is not a mere manifestation but is also involved in the pathogenesis of the disease. Lipid-mediated oxidative stress is likely to contribute to endothelial hyperstimulation leading to dysfunction and damage. Maternal predisposing factors seem to be essential to explain why some pregnant women develop a systemic syndrome such as preeclampsia and why others do not. Preliminary evidence suggests that abnormal lipid metabolism could be one of these factors. In this review the evidence for the contribution of lipid oxidation in the pathogenesis of preeclampsia, the similarities between preeclampsia and lipid-mediated chronic vascular disease will be summarized, and the reasons to believe that constitutional lipid abnormalities could be one of the maternal predisposing factors for developing the disease will be examined and will be discussed.