Background: Gestational hypertension is a common but potentially life threatening complication of pregnancy. Till date no accurate diagnostic modalities are available for its early prediction so that adequate timely measures could be taken for prevention, early detection and adequate management. Objective: To evaluate the role of mid-trimester maternal serum βhCG levels for the prediction of development of pre-eclampsia and its severity later in the pregnancy. Methods: The study was a prospective observational study involving a total of 178 randomly selected women, between 13 to 20 weeks of gestation. Early mid-trimester βhCG levels were estimated and absolute values converted to population based multiples of median (MOM) and development and severity of hypertension/pre-eclampsia was observed in the follow up. Results: Out of a total of 178 only 165 women could be followed till end. Among 142 women with mid-trimester βhCG levels< 2 MOM only 2 developed hypertension. Twenty three women had βhCG values >2 MOM and in this group 47.8% women developed severe hypertension (p<0.001). A positive correlation between the severity of hypertension and absolute βhCG levels more than 80000mIU/mL (88935+7835.44; t=6.058; p<0.001) was observed. The chances of caesarean delivery increased with the severity of hypertension. Whereas only 20.6% normotensive women were delivered by LSCS; 11 (55.0%) out of a total of 20 women with gestational hypertension underwent LSCS (p <0.001). Conclusion: Elevated mid-trimester maternal serum βhCG levels could be used as a predictor of development and severity of hypertension in pregnancy.