BACKGROUND: Pre-eclampsia (PE) is a common preventable and potentially life-threatening complication of pregnancy. It is a multisystem disorder complicating 2-5% of pregnancies. The International Federation of Obstetrics and Gynaecology (FIGO) in its 2019 guidelines for combating Pre-eclampsia highlighted the fact that predicting and preventing pre-eclampsia is the solution to this global scourge. Since the nations of the West African sub-region are generally resource-poor, there is a need to seek and ascertain other scientifically reliable but cheaper ways of screening for and predicting pre-eclampsia among pregnant women as a basis for implementing prophylactic measures. Understanding the changes in platelet indices in pregnant women with PE compared with healthy controls will be the first step towards ascertaining the predictive value of platelet indices in the development of PE which will fill the gap in this regard. OBJECTIVES: The objectives of this study were to determine the changes in platelet indices in pregnant women with PE compared with healthy controls and to ascertain the relationship of these indices with the development of PE.METHODOLOGY: This study was a case-control study carried out between October 2020 and June 2021 after ethical approval has been obtained from the Rivers State University Teaching Hospital Health Research Ethics Committee. It involved 50 eligible and consenting pregnant women with PE as cases and 50 healthy pregnant women as controls, all of whom either presented for routine antenatal care or presented for delivery at the labour ward of the Rivers State University Teaching Hospital. Blood samples were collected using a vacutainer and full blood count and platelet indices (platelet count, mean platelet volume and platelet distribution width) were analysed using an automated haematology analyser, Sysmex KX-21N. The socio-demographic information of the study participants was collected using a structured questionnaire. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 25. RESULTS: The sociodemographic characteristics of cases were similar to those of controls. The results found a statistically significant difference in the mean platelet count between cases (176.30  67.38 fL) and controls (207.16  62.07fL), p=0.019 as well as in the mean values of platelet distribution width (PDW) in both cases and controls. The PDW was significantly raised (15.53  3.36fL) compared to controls (13.75  2.53fL), p=.0.004. There was no significant difference in the mean platelet volume (MPV) between cases and controls. The mean value of the MPV was 11.14 ±1.33 among cases and 10.65±1.38 for controls, p=0.075. Using receiver operator characteristics (ROC) curves, the cut-off for the diagnosis of PE was 11.6fL for MPV and 14.5fL for PDW. At this value, the sensitivity of MPV was found to be 36% and specificity was 88% while the positive predictive value and negative predictive value were 73.9% and 42.9% respectively. The sensitivity and specificity of PDW at the cut-off of 14.5 were found to be 66.0%and 72.0% respectively while the positive and negative predictive values were 70.2% and 67.9% respectively. CONCLUSION: The platelet count is significantly reduced in PE compared to controls but has very low diagnostic accuracy. The MPV is not significantly raised in PE when compared with controls. The PDW is significantly raised in PE compared with controls. Rising values of the PDW in pregnant women may be an indication of more focused care within the context of preeclampsia prevention and management.