Pre-eclampsia affects 3 to 8% of all pregnancies. In the USA, pre-eclampsia remains a leading cause of maternal morbidity and mortality, comprising 17% of maternal deaths in advanced gestations in 1999. The pathophysiologic changes associated with pre-eclampsia can have a profound impact on the uteroplacental unit and fetal and neonatal outcome. Equally important are the adverse effects on the maternal hematologic, cardiovascular and pulmonary, neurologic, renal, and gastrointestinal system. This article aims to review complications of pre-eclampsia as they impact on the cardiovascular and pulmonary systems.