ABSTRACT Objective The aim of the study was to investigate the role of systemic immune‐inflammation index (SII), systemic inflammation response index (SIRI), and pan‐immune inflammation value (PIV) calculated from first trimester complete blood count (CBC) in predicting preeclampsia without (PE) and with severe features (PE‐SF). Methods This retrospective cohort study included 126 women with PE, 126 women with PE‐SF, and 126 women with healthy, normotensive pregnancies delivered at a large tertiary referral hospital between 2018 and 2022. The main outcome measures were SII, SIRI, and PIV. Results SII scores differed significantly between the control versus PE and control versus PE‐SF groups, while SIRI scores showed a significant difference between the control versus PE and PE versus PE‐SF groups. However, the PIV values showed a significant difference in all three groups. According to the receiver operating characteristic analysis performed for the discriminatory power of SII, SIRI, and PIV, the area under the curve (AUC) values were 0.801, 0.609, and 0.774 for the prediction of PE and 0.535, 0.701, and 0751 for the prediction of PE‐SF, respectively. An SII with a cutoff value of > 620.59×10 3 /µL (sensitivity 81%, specificity 67%) and an SIRI with a cutoff value of > 0.94×10 3 /µL (sensitivity 74%, specificity 69%) had the highest discriminatory power for the prediction of PE and PE‐SF, respectively. Conclusion Our results suggest an association between high SII, PIV, and SIRI results and an increased risk of future PE and could be used as a first trimester screening test to improve decision making in the prediction of PE.