Objectives <p>Eclampsia is a leading contributor of severe maternal morbidity in the United States. Although the rates of severe maternal morbidity for Asian and non-Hispanic White birthing people are similar, variations in eclampsia risk across Asian origin groups have not been adequately studied.</p> Methods <p>A cross-sectional study using public access Natality Files data (2018–2021). The exposure was maternal race (non-Hispanic White or Asian), and nativity (foreign- or US-born), with foreign-born non-Hispanic White birthing people defined as the reference group. The outcome was eclampsia. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) of eclampsia associated with race and nativity were estimated using multivariable logistic regression models.</p> Results <p>Of the 8,295,025 birth certificates analyzed, 21,547 (26.0 per 10,000) recorded eclampsia. The incidence of eclampsia per 10,000 was 14.7 for foreign-born White people, 26.7 for US-born White, 20.9 for foreign-born Asians, and 49.6 for US-born Asians. Among Asian origin groups, the highest incidence of eclampsia per 10,000 was observed among US-born Japanese (256.0), followed by US-born Filipinos (120.6), foreign-born Filipinos (82.9) and US-born Japanese (32.7). After adjustment and compared to foreign-born White people, US-born Filipinos had the highest odds of eclampsia (aOR: 9.36; 95% CI: 7.51, 11.67), followed by foreign-born Filipino (aOR: 6.09; 95% CI: 4.95, 7.50), US-born Japanese (aOR: 4.89; 95% CI: 3.45, 6.92), foreign-born Japanese (aOR: 3.18; 95% CI:2.26, 4.47), and US-born non-Hispanic White (aOR: 2.13; 95% CI: 1.96, 2.32).</p> Conclusions for Practice <p>Eclampsia risk varies significantly across Asian origin groups and by nativity.</p>