Polycystic ovary syndrome (PCOS) occurs in 5–18% of women in reproductive age. According to recent meta-analyses the risk of pre-eclampsia in pregnancies of women with PCOS is significantly higher than in women without this diagnosis, with an odds ratio of 2. Hyperandrogenism increases the risk, while the other diagnostic criteria, such as anovulatory menstrual disorders and high ovarian reserve, do not have a direct impact on the development of pre-eclampsia. Other risk-modifying factors are insulin resistance, overweight and obesity. It can be caused by many factors, such as chronic inflammation, metabolic factors, pregnancy after assisted reproduction but also genetic alterations. Studies show an increased risk of pre-eclampsia in women with PCOS, even if the causality has not yet been proven and biomarkers to assess the individual risk are lacking. The elevated risk and the estimation of the risk of pre-eclampsia should be considered within the antenatal care of women with PCOS.