To estimate serum levels of tumor necrosis factor-α (TNF- α), interleukin (IL)-6 and IL-10 in primigravida women at the 12th week of gestation and to evaluate its predictability for later development and severity of pre-eclampsia (PE). Patients & Methods: The study included 130 primigravida women evaluated at the 12th week gestational age clinically to assure being normotensive and gave blood samples for ELISA estimation of serum levels of TNF-α, IL-6 and IL-10. All patients were evaluated 4-weekly for development of PE that was categorized as early or late and mild or severe. Results: Sixty-five women developed PE; 23 early PE and 42 late; 47 mild and 18 severe PE. Serum TNF-α and IL-6 levels were significantly higher, while serum IL-10 levels were significantly lower in PE than control women with significantly higher IL-6/IL-10 ratio in PE women. ROC curve analysis defined high body weight, body mass index, high serum IL-6 and TNF-α and high IL-6/IL-10 ratio as significant specific predictor, while low serum IL-10 as a significant sensitive predictor for possibility of development of PE. Also, ROC curve analysis defined high IL-6/IL-10 ratio as significant sensitive predictor for severe PE, while defined high serum IL-6 and high TNF-α as significant specific predictors for mild PE. Conclusion: Pre-eclampsia was associated with shift of immune response to pregnancy towards production of pro-inflammatory cytokines. The detected early disturbance of immune milieu points to its role in pathogenesis of PE. High IL-6/IL-10 ratio early in pregnancy could predict later development of PE especially severe PE. High IL-6 and TNF-α serum levels could early predict the development of mild PE.