Abstract: Background: Preeclampsia is a hypertensive disorder of pregnancy that significantly contributes to maternal and fetal morbidity and mortality. Its pathogenesis is closely associated with angiogenic imbalance, particularly decreased levels of Vascular Endothelial Growth Factor (VEGF) due to increased anti-angiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1), leading to systemic endothelial dysfunction. Objective: To compare serum VEGF levels between pregnant women with preeclampsia and normotensive pregnancies and to evaluate the diagnostic performance of VEGF as a predictor of preeclampsia. Methods: This analytical observational study with a case-control design included 40 subjects (20 preeclampsia and 20 normotensive pregnancies) at H. Adam Malik General Hospital and affiliated centers. Serum VEGF levels were measured using ELISA. Statistical analysis was performed using the Mann–Whitney test and Receiver Operating Characteristic (ROC) curve analysis (p<0.05). Results: Serum VEGF levels were significantly lower in the preeclampsia group compared to normotensive pregnancies (8.03±3.27 vs 39.78±24.39 pg/mL; p<0.001). Median values also showed consistent differences. ROC analysis demonstrated excellent diagnostic performance with an AUC of 1.000 (p<0.001). The optimal cutoff value of 14.9 pg/mL yielded 100% sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy.Conclusion: VEGF levels are significantly decreased in preeclampsia and demonstrate excellent potential as a reliable biomarker for predicting preeclampsia, supporting its use in early clinical assessment.