There seems to be a correlation between preeclampsia and congenital abnormalities, but whether it is positive or negative is a matter of controversy. Since it has been demonstrated that reduced perfusion of the trophoblast, which is an early feature of preeclampsia, can also represent a cause of fetal malformation, a positive correlation between the two conditions should be found. In the search for such a correlation we retrospectively examined 8,894 cases collected until 1994 by the IMER group (Indagine Malformazioni Emilia-Romagna). In the presence of malformation a higher incidence of preeclampsia was found (4.60 versus 3.47) with an odds ratio of 1.34 (95% CI = 1.08-1.67). Furthermore multivariate analysis showed that malformations of the male genital apparatus and those named 'multiple congenital abnormalities' can be considered as risk factors for preeclampsia. Since it is known that the development of male genitalia occurs under the influence of androgens, it can be hypothesized that hypoxia could act by favoring low end organ responsiveness. In our opinion the positive correlation with fetal malformations should be interpreted as clinical evidence of the early onset of the physiopathologic mechanism of preeclampsia.