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Introduction- Hypertensive disorders of pregnancy (HDP) have an underlying mechanism of altered immune response. However there is conflicting evidence regarding predictive role of inflammatory markers for HDP. Objective - To evaluate the systemic inflammatory markers such as differential leucocyte count , neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR) in early pregnancy and correlate with the development of hypertensive disorders of pregnancy. Methods- In a prospective observational study,136 pregnant women aged 18-40 years were recruited before 12 weeks of gestation. Complete blood count including hemoglobin, differential leucocyte counts were measured at 12-14 weeks and 18-20 weeks of gestation. NLR, MLR and PLR were calculated after obtaining the absolute values. All pregnant women were followed with regular antenatal care and outcome measures like development of Gestational hypertension, preeclampsia and IUGR were noted. Result: Out of136 pregnant women,8.82% developed GH,18.4% PE and 72.7 % were normotensive (NT).The mean age(P= 0.590) was similar while BMI (NT=23.8?3.81,GH=27.2?6.01,PE=27.7?6.06; p=0.09) was more in women with HDP. At 12-14 weeks of gestation. the NLR (p=0.017) and PLR (P=0.015) was more in GHTN than PE or controls (GHTN- 4.82?1.76, NT- 3.64?1.36, PE -3.67? 1.16). TLC of ?10.5 predicted the development of GH with AUC of 0.735 (p=0.008) with sensitivity and specificity of 67% and 74% respectively. NLR at cut of value of?3.76 and PLR at cut off of ?11.8 with AUC of 0.713 at 12-14 weeks of gestation predicts GHTN with 67% sensitivity and 66% specificity. Conclusions-This study suggested that GH has an altered immune response early in the course of pregnancy (at 12-14 weeks).This emphasizes the fact that GHTN may involve the same etiology of exaggerated inflammatory response as involved in essential hypertension. PE has a non inflammatory basis and develops in otherwise healthy women.