Background: Pre-eclampsia and eclampsia are pregnancy specific disorders characterized by hypertension and proteinuria. They are associated with poor perinatal outcomes such as maternal and neonatal mortality and morbidity. This study aimed to determine prevalence and risk factors for pre/eclampsia among women who delivered at Kilimanjaro Christian Medical Centre. Methods: A cross-sectional study was conducted using secondary data from Kilimanjaro Christian Medical Centre medical birth registry. Socio-demographic, clinical and birth outcomes from women with gestational age ≤28 weeks whose deliveries were registered by the birth registry from 2000 to 2014 were analyzed using STATA version 13. Descriptive statistics were performed to summarize the data. Logistic regression models were used to estimate the association between explanatory variables and pre/eclampsia. P-value of less than 0.05 was considered statistically significant. Results: A total of 40,176 mothers with 50,807 deliveries were analyzed. The prevalence of pre/eclampsia was 4.2%. After adjustment various factors remained positively associated with an increased odds of pre/eclampsia include maternal age of ≥35 years (AOR = 1.73), ≥12 years of education (AOR=1.29), unmarried (AOR=2.03), overweight (AOR=1.99), obesity (AOR=5.52), hypertension (AOR=18.66), anemia (AOR=3.53) and multiple pregnancies (AOR=6.58). On the other hand, alcohol consumption (AOR=0.69), ≥4 antenatal care visits (AOR=0.78) and HIV positive status (AOR=0.39) were protective against pre-eclampsia and eclampsia. Conclusions: Pre/eclampsia remains a significant concern for women in this region. Many of the risk factors associated with these condition are the same for other non-communicable diseases diseases (overweight, obesity and hypertension). Early identification of these factors and targeted interventions at at-risk women are needed to reduce the prevalence and subsequent maternal and neonatal mortality and morbidity. Improved uptake of antenatal care visits was shown to be associated with decreased odds and should therefore be expanded and further explored. Key words: prevalence, pre-eclampsia, eclampsia, risk factors martanal health, birth outcomes, Tanzania.