Marked dyslipidemia may contribute to endothelial cell dysfunction in pre-eclampsia. Carriers of N291S or D9N missense mutations in the lipoprotein lipase (LPL) gene exhibit reductions in LPL activity and are predisposed to dyslipidemia and cardiovascular disease. In Caucasians, the D9N variant is in strong linkage disequilibrium with the - 93T --> G promoter variant. A fourth LPL variant, S447X, is often associated with a beneficial lipid profile. We asked if the N291S and the combination D9N/- 93T --> G variants are more prevalent, and if the S447X variant is less prevalent, in Caucasian women with pre-eclampsia as compared with normal pregnancies. DNA amplification was followed by an allele-specific oligonucleotide ligation assay. Allele frequencies were analyzed with a chi2 table and Yates' correction. The N291S variant was identified in 11.1% of pre-eclamptics as compared with 2.9% of pregnancy controls (p = 0.008). All carriers of D9N were also carriers of - 93T --> G. The D9N/ - 93T --> G combined variant was found in 7.1% of pre-eclamptics as compared with 1.4% of pregnancy controls (p = 0.02). No individuals were carriers of both N291S and D9N/ - 93T --> G. Thus, 18.2% of pre-eclamptics had either of these LPL mutations compared with 4.3% of pregnancy controls (and 4.4% of population controls). The frequency of the S447X variant did not differ among groups. We conclude that carriers of N291S or combined D9N/ - 93T --> G mutations in the LPL gene are at substantially increased risk of pre-eclampsia.